A Review of An Elegant Defense

By Dr. Scott Hamstra, STChealth Medical Advisor & Dale Dauten, Syndicated Columnist

If you have a few days to dwell on immunology, then may want to read An Elegant Defense by Matt Richtel. The author is a writer for the New York Times and he writes entertaining stories, but he also writes long – the main section of the book goes over 400 pages. So, if you don’t have time, we have assembled ten lessons.

10. STARFISH LARVA AND THE ORIGIN OF IMMUNOLOGY. There’s some debate about the start of immunology. Chickens and dogs figure into the debate, but we’re going with starfish. It was in 1882 that Elie Metchnikoff, a Russian zoologist, peered through microscope at starfish larva, which are transparent, and seeing cells moving inside, wondered how they’d react if he stuck in a splinter. The cells swarmed the invader and, quoting Elegant Defense, “appeared to eat away at the offending or troubled tissue.” Metchnikoff called this the “phagocyte theory,” the term loosely translating to devourer of cells.

9. WEREWOLVES ARE IN THE STORY. One of the most bizarre etymologies for any medical term is the one for the autoimmune disease lupus. It comes from the Latin for “wolf,” and while Hippocrates himself observed the symptoms, it was someone called Heberus of Tours who suggested that the condition’s skin lesions resembled wolf bites and came up with the name lupus. This apparently led to the wild speculation that the marks were “a sign that someone had turned into a werewolf.” And that was long before social media.

8. YOU ARE A SUPERORGANISM. People are 99.9% similar in our human DNA, yet our microbiome varies by 80-90%. The GOOD NEWS — most are not just friendly, they are interactive partners supporting us. They help educate our immune system on the handful of “bad actors” (pathogenic microbes). This duality creates our SuperOrganism status — achieved by a combination of human and microbial species and genes.

(FYI: We are vastly outnumbered by microbes:  500 species in our mouth, 500 species in the airways, and (wow!) 300 M on our skin. Over 1,000 species of microbes with over 5M genes in our gut versus human DNA of just 22,000 genes.)

7. YOUR IMMUNE SYSTEM IS BUILT FOR HARMONY, NOT WAR. While the metaphors for the immune system are usually martial, Richtel insists, “Your immune system isn’t a war machine. It’s a peacekeeping force that more than anything else seeks to create harmony.” He further describes the human body as a “festival of life,” open to all sorts of lifeforms. The immune system passes through the crowd and escorts out the party crashers, the troublemakers. This distinction argues for a “Goldilocks syndrome” or need to strike just the right balance — not too little or too slow a response AND not too fast or too hostile (resulting in autoimmune disease).

6. WHY STRESS MESSES WITH THE IMMUNE SYSTEM. You’d think that stress would give a goose to your immune system, but no. Just the opposite – it makes you more vulnerable to infections. In evolving to deal with the original stressors, like bears, the body doesn’t want to mess around with the fever and fatigue of an immune response; instead, a surge of adrenaline precedes a release of steroids to suppress the immune system in favor of maintaining blood pressure and blood flow.

5. NO MORE 5-SECOND RULE. Here’s the quote from An Elegant Defense: “Dr. [Meg] 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 over-sanitizing 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.”

4. WHO GOES THERE? One job of the immune system is figuring out “Self vs Non-Self” — it’s part of the body’s security team answering the critical question, “Friend or Foe?” One of the insights into cancer is that it tricks the immune system into supporting and protecting these “self” cancer cells from “enemies” or treatments. Advances using monoclonal antibodies to activate and unleash the power of the immune system to detect and ignore these tricks and destroy these rogue cells is one of key advances of modern medicine.

3. MAGIC JOHNSON, STILL ALIVE. It’s been nearly thirty years since Magic haltingly said, “Because of the HIV virus that I have attained, I will have to retire from the Lakers.” That was November 7, 1991. Everyone who heard those words heard, “death sentence.” So why didn’t Magic die? Yes, there were treatments coming out, like AZT, but even before the treatments, there were individuals who got HIV and lived, their immune systems able to contain it. Such lucky folks are known as “elite controllers” and they are one way the species insures survival – everyone on the planet has a unique immune system and thus some percentage of the population has been immune to every bacteria and virus… so far.

2. IMMUNOLOGY: WE ARE THE WORLD. Not only does our immune system hold an amazing diversity of defense mechanisms and strategies, the people figuring that out the immune system have diversity of their own: A Japanese scientist, studying in San Diego, made a discovery in Switzerland that our DNA rearranges itself in utero to form millions of antibodies capable of recognizing and reacting a trillion antigens. An Australian veterinarian worked with a transplanted Swiss scientist to discover that the T cell distinguished self from non-self, and a Russian found that we have not one, but two immune systems. 

1. YOU HAD ME AT HELLOOOOO.. WHAT’S THAT SMELL?” Your immune system’s MHC (major histocompatibility complex) allows your T cells to diagnose illness inside cells and then choose which to pass by and which to assassinate. But here’s where it gets surprising: “Studies have shown the MHC gene gives off a scent. The scent is used as a factor is how people choose their mates. If one person’s MHC is too similar to another’s, the MHC will act as a repellent. The scent of MHC that is sufficiently different will act as a magnet.” Said another way, the diversity of our immune system is so important to our evolution that it drives sexual attraction.

Could this finally explain some of those surprising marriages?

My Travels Though Covid Country Or What Would John Snow Do?

By Bill Davenhall, Geomedicine Analyst, STChealth Analytics

Anybody who has ever studied public health issues anywhere in the world knows the name of John Snow, the public health worker in London who removed a water pump handle to stop the spread of cholera in the Westminster neighborhood. But, how many can recall the name of the census enumerator who tallied all the cases and deaths, every day, everywhere, and marked each death on a map? John Snow had irrefutable facts of the cases and deaths, and since most people died either in their homes or on the street, it was very observable to all in the neighborhood. Okay, now hold that thought…

For the last 30 days, and over 2,000 miles of car travel across much of America’s southernmost geography from Phoenix, Arizona to my new home near Orlando Florida, my wife and I traveled through seven states. Generally, I would say that mask wearing is most common in retail settings – you come to expect to see employees of most establishment wearing masks, and when you see that, you tend to see customers with masks. It only took us about 200 miles to determine that sticking with a national brand service was important if you wanted to be in places that were following CDC guidelines. We quickly learned how to avoid “independent” operators unless they made it obvious that they were complying with the best available CDC guidance.

So, what does this have to do with analytics and the story of John Snow?

For starters, it takes us quickly to the implications between observable, tangible facts vs theoretical discussions. We are also learning a great deal about masking and social distancing — both are “facts” we can observe firsthand, every day, everywhere. It will be hard however to measure the personal impact each person will make or receive by their individual choice and in most cases we will never know the specific outcome.  In the present chaos over what works we seldom have enough clear facts to make judgements. So, we arrive at trust, and here is the statistical “rub”: trusting other people’s data or their interpretations, is always a risk we all take – from seat belt use to smoking to virus protection. Seems like there is some credibility is “seeing is believing,” so a warning to all those data analysts out there in public health. Do not expect your facts to be trusted, in fact, expect them to be debated with great enthusiasm… much like wearing masks. If everybody does it (a norm) it’s more likely to work, and the wearing becomes a moot point; however, if it is seen as a fad, it will lose its appeal quickly and any gains from the expectation of universal mask wearing will fade away. The greatest damage to building trust is in “playing” with the facts that are observable and accurately generated. Actual numbers seldom mess with our trust, as it is the interpretation of those facts that trips us up. When the numbers themselves become questionable, then they become candidates for editorialization about what they mean or worse, subject to distrust. The only antidote is total transparency of analytical methods and the personal integrity of those who collect and report the data to the public without political interference.

Back to John Snow: the London board of health tried to fire John Snow — but then people stopped dying from cholera after he removed the water pump handle. John stuck to his data and did not back up; he had the facts and knew they were accurate – then he acted. and thus, delivered the best possible outcome – Londoners stopped dying from Chorea. Hard to refute the observable facts. As always, 2nd opinions encouraged.

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