Review by New York Times Review
The measles outbreak prompts a look at the tumultuous history of vaccination. WHO WOULD EVER have predicted that this winter's grim medical headlines would address not the usual coldweather pestilence - influenza - but pedestrian, forgettable old measles? Just about everybody, that's who. Experts have been tracking the worldwide resurgence of measles for decades now, and it was only a matter of time before the scattershot outbreaks of years past turned into this year's newsworthy explosions. Readers curious about this infection rising phoenixlike from its own ashes will find both less and more in the library than they may want. Aside from a few textbooks and pamphlets, 1 couldn't find a whole book devoted to measles - not since the 10 th century A.D., that is, when the Persian physician Al-Razi wrote "The Smallpox and Measles" to differentiate the two. Still, quite a few recent books deliver the basics, including information on childhood infections and their medical dangers, the various ways we have learned to thwart those dangers and the ways in which those efforts have in turn been thwarted. Readers intrigued enough by vaccination to want more details on the workings of the human immune system and its potential for both harm and good will find new books discussing just that topic. For a detailed review of diseases, vaccines and the objections the anti-vaccine lobbyists have brought to the table, books by the prolific Paul Offit are a good place to start. Offit is a pediatrician and infectious disease expert in Philadelphia whose longtime, eloquent advocacy of vaccination has made him a permanent target of anti-vaccine lobbyists - his book signings have sometimes been canceled because of credible death threats. Offit's "Deadly Choices" (2010) outlines the often-forgotten complications of childhood infections and rebuts the various objections of the anti-vaxxers point by point. "Autism's False Prophets" (2008) concentrates on the thoroughly debunked assertion that the neurological condition autism results from childhood vaccines. But it is "Bad Faith" (2015), Offit's analysis of the tension between religious fundamentalism and vaccination, that speaks most directly to this year's headlines with a short, unforgettable section on measles. During the winter of 1990-91, more than 1,400 adults and children in Philadelphia developed measles, and nine children, all unvaccinated, died. Offit's dispassionate, methodical summary of the religious and political theories that enabled that giant outbreak simmers with anger. Living through that epidemic, he has since written, "was like being in a war zone." If expert opinion from a war zone is not an appealing perspective on the subject, readers will find similar territory covered in an utterly different voice by Seth Mnookin in his excellent "The Panic Virus" (2011). A journalist with no skin in the vaccine game - other than the fact that he was a new father when he wrote the book - Mnookin just wanted to explore the minefield for himself. As he tentatively lays out vaccine pros and cons he becomes convinced of the fallacies and dangers in the anti-vaccine movement's rhetoric. His reflections on the actress Jenny McCarthy, whose transformation into anti-vaccine advocate revived a fading Hollywood career, make for a fun, snarky read, but the enduring importance of Mnookin's book lies in its methodical science-based rebuttals of wild rhetoric. If histrionic behavior and snark appeal to you, you can get quite a dose of both from the stories of some of the vaccine scientists themselves. Offit's "Vaccinated" (2007) profiles one of the 20th century's foremost vaccinologists, Merck's powerful and spectacularly foul-mouthed Maurice Hilleman, and sketches out the climate of fierce scientific competition and politics in which he thrived. The science journalist Meredith Wadman took a deep dive into similar material and created a real jewel of science history. Wadman's "The Vaccine Race" (2017) brims with suspense and now-forgotten catastrophe and intrigue, all beginning in the 1950s and 1960s, when, as she writes, the chase for new vaccines "was as hot as today's quest to unravel the profound mysteries of the human genome." The first vaccinologists were accustomed to working in happy solitude, policed by conscience alone - or not, as the case may be (some were really wildly unprincipled). Soon enough, though, the scientists were joined in their projects by academics and salesmen, then by corporate executives, then by congressmen and lawyers. All were forced to navigate the terrible early vaccine disasters, when contaminated products transmitted disease rather than protection, and all struggled with the need to reconcile centuries-old public health tools, like quarantine, with new ones like mandatory vaccination and informed consent. Wadman's smooth prose calmly spins a surpassingly complicated story into a real tour de force. Vaccination was only the first organized effort to harness the immune system for medical purposes. In the last two decades many other techniques have been devised, foremost among them the engineered proteins called monoclonal antibodies. These are the pricey drugs with unpronounceable names ending in "-mab" now being hawked incessantly on television for diseases from eczema to cancer. The story of the science behind these drugs and other sophisticated immunologic tools is just beginning to be written. In his new book, "The End of the Beginning" (Pegasus, $27.95), the immunologist Michael Kinch builds on a narrative he began last year in "Between Hope and Fear." That book profiles the immune system and the origins of modern vaccine science, draping it all with digressions into biography, philosophy and history. Kinch now changes focus slightly to review cancer biology and the promise of immune-mediated treatments. A professor at Washington University in St. Louis, he spent some of his early career at a biotechnical company and can speak with authority about the mixed promise of monoclonal antibodies for cancer treatment - some tumors vanish with these agents while others are utterly untouched, and none of the drugs is without side effects. Kinch's narrative is as loose and lavishly ornamented as ever, while his material is, if anything, even more scientifically complex. Some readers may enjoy the bumpy, glittery, distraction-filled ride. Others, presumably those of us with dull linear minds, will wish he would just settle down, even for a single chapter, and say what he has to say in a dull, straightforward way. Matt Richtel wanders different paths in the same territory with "An Elegant Defense" (Morrow/HarperCollins, $28.99), also published this spring. Areporter for The New York Times, Richtel became interested in immunology after a childhood friend developed Hodgkin's lymphoma in his early 40s. Hodgkin's is one of the more curable cancers of adulthood, but Jason Greenstein was in the unlucky minority of patients who have terrible, prolonged downhill courses. Richtel told portions of Jason's story in a Science Times series on the promise and perils of immunologic therapy: With a last-ditch experimental monoclonal antibody treatment, Jason's huge, disfiguring tumors melted away like warming ice cubes - a visible miracle, if sadly short-lived. Jason died in 2016. Richtel's deep affection for his irrepressible friend animates much of his book, and his stories of three other individuals whose illness or wellness can be ascribed to their unique immunologic makeup are interesting enough, if less affecting. But when Richtel attempts to explain the basic science underlying autoimmune disease and immunologic treatment, he is palpably out of his depth. Dozens of different immune cells and chemicals keep us healthy and can also make us grievously sick; their habits and functions are often opaque and the nomenclature is beyond confusing. Even a professional narrator like Richtel, forced to operate without tables and figures, is bound to get all tangled up in his prose and generate a few real bloopers. That's why some wise educator long ago created textbooks.
Copyright (c) The New York Times Company [May 12, 2019]
Review by Booklist Review
Pulitzer Prize-winning reporter, nonfiction writer, and crime novelist Richtel adroitly mingles cellular biology, scientific history, medical research, and patients' experiences as he explains how the immune system primarily protects our health but is also implicated in cancer, AIDS, and autoimmune disorders (e.g., rheumatoid arthritis, lupus). He explores how the immune system recognizes self and other and how it distinguishes biological partner from biological foe. Richtel's discussion of immunology encompasses T cells and B cells, monoclonal antibodies, inflammation and fever, the human microbiome, and allies of the immune system (vaccines and antibiotics). Four individuals are cast as the faces of either hyperfunctioning or less than optimal immune systems. Jason, the author's friend from childhood, has late stage Hodgkin's lymphoma. Linda and Merredith have autoimmune diseases. Bob is HIV-infected but asymptomatic. The hygiene hypothesis gets hyped with one MD seriously suggesting, You should not only pick your nose, you should eat it (a yucky way perhaps to give your immune system a frequent workout). Ancient and intricate, highly effective and ever vigilant, your immune system is engaged in a perpetual biological balancing act, making trade-offs to keep the peace, to maintain homeostasis, to let the individual live as long as is practical."" Richtel approaches this essential subject with awe, his writing meticulous and empathic.--Tony Miksanek Copyright 2010 Booklist
From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Publisher's Weekly Review
New York Times reporter Richtel (A Deadly Wandering) takes on "one of the world's most complex organic systems" in this entertaining survey of the science of immunology. In punchy prose ("Picture a festival-a wide-open, take-all-comers bash. This is life inside your body"), Richtel covers the history of research into the field, including Jacques Miller's thymectomies on mice in the 1950s and '60s, which led to the discovery of T cells, a key immune system component; Peter Doherty's more recent work on the major histocompatibility complex or MHC, "the single most varied or polymorphic of all human genes"; and, in the '90s, the contributions of multiple scientists to HIV research. He also provides close-ups on the case histories of four people, including two women suffering from autoimmune disorders, interwoven through discussions of myriad present-day concerns: the recent spike in allergies in children; the dangers of overprescribed antibiotics; the problems that modern, antiseptic, and stress-filled lifestyles pose for the immune system; and the growing importance of monoclonal antibody therapeutics. In the course of examining "the broader environment surrounding our immune systems," Richtel creates a hard-to-put-down account of the body's first line of defense. Agent: Laurie Liss, Sterling Lord Literistic. (Mar.) © Copyright PWxyz, LLC. All rights reserved.
(c) Copyright PWxyz, LLC. All rights reserved
Review by Library Journal Review
The human immune system is a true wonder. It defends the body against disease, but it can also turn against its host. Pulitzer Prize-winning New York Times reporter Richtel (A Deadly Wandering) uses four case histories to present this intricate system and its functions. In the process, he covers the history of important discoveries, the components of the system, and their processes. The narrative brings famous scientists such as Élie Metchnikoff and Paul Ehrlich to life, vividly portrays phagocytosis, and explains the intricate work of antigens and antibodies. If the immune system is not active enough, HIV/AIDS or cancer can attack. If it is too active, type 1 diabetes or lupus may occur. The author makes complex science accessible to lay readers while they explore a nonfiction page-turner. VERDICT An engaging story that promotes awareness of a body system that protects us. Public and consumer health libraries should consider this -essential.-Barbara Bibel, formerly Oakland P.L. © Copyright 2019. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review
An expert examination of the immune system and recent impressive advances in treating immune diseases.Scientists describe the brain as the most complex organ, but novelist and Pulitzer Prize-winning New York Times journalist Richtel (A Deadly Wandering: A Tale of Tragedy and Redemption in the Age of Attention, 2014, etc.) maintains that our immune system gives it a run for its money. Around 3.5 billion years ago, the earliest cells developed means to identify alien threats and (usually) fight them off. As organisms evolved greater complexity, their immune systems kept pace with mammals, humans included, which possess a dazzling collection of organs, tissues, wandering cells, DNA, messengers, and chemicals keeping watch on our "festival of life." "The thymus makes T cells," writes the author. "The bone marrow is the origin of B cells.The T cells, when alerted by dendritic cells, behave as soldiers, spitting out cytokines; the B cells use antibodies to connect to antigens as if they are keys in search of a lock. Macrophages, neutrophils, and natural killer cells roam the body, tasting, exploring, and killing." In the first of many jolts, Richtel downplays the claims of enthusiasts who urge us to attain the strongest possible immune system. Immunity resembles less a comic-book superhero than a trigger-happy police force, equally capable of smiting villains and wreaking havoc on innocent bystanders. To illustrate, the author devotes equal space to its role in fending off threats (infections, cancer) and attacking healthy tissues during allergies and autoimmune diseases such as asthma, diabetes, colitis, rheumatoid arthritis, and lupus. Scientific breakthroughs in producing specific antibodies have led to spectacularly effectiveif toxic and wildly expensivetreatments for many. A newsman's truism insists that readers love articles that include real people, so the author introduces us to four. All illustrate the good and bad features of modern immunotherapy, but the courses of their diseases are too bizarre to be typical.Richtel illuminates a complex subject so well that even physicians will learn. Copyright Kirkus Reviews, used with permission.
Copyright (c) Kirkus Reviews, used with permission.
