Review: An Elegant Defense

An Elegant Defense is a book about our understanding of the human immune system, and how that has affected the life of patients. I ton of the content overlapped with The Breakthrough, but since I read the book several months apart, I didn't mind as much as if I'd read them back to back.

The history of immunology was great, granting me several perspectives I didn't know before, including how much AIDS impacted the field, and why the cocktail of drugs used to control the progress isn't considered a cure. (the drugs have a ton of side effects)

As with The Breakthrough, there's some emphasis towards the end about how "boosting your immune" system is just crackpot marketing, and if you ever actually managed to boost your immune system, it's not necessarily a good thing --- your immune system is carefully balanced on a knife's edge between attacking pathogens and attacking your own body parts. The effects of an auto-immune disorder can be devastating.

The book covers the hygiene hypothesis as well, which I haven't seen in other books:

Dr. Lemon thinks one great way to keep your immune system in balance is to . . . eat the food you drop on the floor. Her philosophy, as she puts it, is that people need to stop oversanitizing their world so that their immune systems are introduced to lots of bacteria, parasites, and other pathogens and can react to them as millions of years of evolution have refined them to do. This philosophy is increasingly widely held. It is called the hygiene hypothesis, and the broad idea is that we are starving our immune systems of training and activity by an excessive obsessive focus on cleanliness. “I tell people, when they drop food on the floor, please pick it up and eat it. Get rid of the antibacterial soap. Immunize! If a new vaccine comes out, run and get it. I immunized the living hell out of my children. And it’s okay if they eat dirt. We have animals in our homes, and they sleep with us. If your dog shits on the floor, clean it up, of course, but don’t use bleach. You should not only pick your nose, you should eat it.” Seriously? Yeah, Dr. Lemon says, why not? “Our immune system needs a job. We evolved over millions of years to have our immune systems under constant assault. Now they don’t have anything to do.” Our elegant defense has grown restless. (Kindle Loc 2780)

 The interaction between cancer and the immune system is also fascinating, with interesting discussions like:

What she and others discovered begins to explain why things like smoking or coal mining or sunbathing are so carcinogenic. Each activity injures the tissue and damages the DNA. When the tissue is damaged, the immune system kicks in and cleanses the site and helps stimulate new tissue growth. The trouble is that when the DNA is damaged, the new cells that grow can be malignant cells, some that are made up of self but that are different enough to behave like a cancer. These cells aren’t playing by the normal rules of the body and staying within their boundaries. Add all this together and you can wind up with cancerous cells that are protected and even nurtured by the immune system. (Kinle Loc 3626)

The weak parts of the book is all that anecdotal stuff. The characters he uses as examples of patients who are benefiting from our new understanding of immunotherapy are by and large unsympathetic and seem like the kind of person you'd want to avoid meeting if you were to run into them in real life, which means I'm left scratching my head as to why I would want to be introduced to them in a book!

But the rest of it, while fluffily written English-major style, is mostly good. Recommended.