tv Matt Richtel An Elegant Defense CSPAN April 7, 2019 8:01pm-9:04pm EDT
shop here all the time. i to pick it on - - typically like to embarrass him with a story but because we have been friends for ten or 12 years , so many stories. but today i will class it up and mention a journalist writing for "the new york times" a pulitzer prize. the author five thrillers how i got to know him and the author of this is the second nonfiction work please join me to welcome matt richtel. [applause] . >> i realize we have been over several times with a book reading about a serious
cerebral topic like the immune system and there is three reasons and number one to find a chapter truly called should i pick my nose and this reason and the least important that i begin this reading this that i wrote a few years ago represents my own misconceptions which i will explain later. the second reason is that c-span is here and i understand they almost always require a medical related acoustic song on book tv so i felt i should honor that. [laughter] but the third and real reason is despite what you think you
will give a warm round of applause because the guy who inspired this book and was a very good friend and why is not happy unless the tide was down this is for you jason don't pick your nose. ♪ ♪ lean close and i will tell you a tale about the one that got away. ♪ not a fish or gargantuan whale. ♪ it started with a little dig a scratch or an itch don't you see. ♪
but it got too big to be an allergy. ♪ the runaway booger you did not believe in sugar darth vader's death star that crushed that day. but there is a prescription. you know, what it is. ♪ don't pick your nose. don't pick your nose. ♪ no co- knot with fingers or toe toes. ♪ now a little guitar interlude. and now coming around to another chorus. . >> slipping out of you at a serious pace and with a giant
tissue s not rocket you can see from space. ♪ with booger sugar and the death star that nearly crush the town. that day. ♪ don't pick your nose. ♪ don't pick your nose. ♪ not with fingers not with toes. not with your sisters or your brothers. ♪ one for the ages your soul to keep looking for redemption let's see how it goes. ♪ don't pick your nose. the runaway booger.
♪ that nearly crush the town that day. don't pick your nose. ♪ don't pick your nose. ♪ not with fingers or with toes. not with your sisters or your brothers. don't pick your nose. [applause] [applause] . >> welcome to an elegant defense. so later on we will tell you about the controversy over nose picking the first i want to tell you about my childhood
my little league baseball team and right here in the front row this is jason and his dad joel. they launch the book. when i was growing up he was mister everything. he was all state baseball and basketball and was a great looking guy. on that graduation day in high school we stayed friends. he was an unbelievable character and unbelievable guy and life was rich except one big blemish. in 11th grade just before the picture was taken, who wears a tighten in our town , he died of cancer in that through jason for a loop.
fast-forward 30 some years he is in his forties but the very age his dad got cancer he got cancer. it was hodgkin's it is curable by cancer standards this is of the bad one to have if you have to have it. he didn't just manage to survive but so did his cancer. his life did not stay on track as when his dad was around and he missed some treatments but then three years ago 201316 pounds of lymphoma in his back doubling every week and oncologist said i love you
but it's time to go home and i. we all said goodbye. and he went home. he said what about that one drug in their last meeting with the oncologist that was immunotherapy that we hear a lot about them now. off label at the time not marketed for what he had not even sold are available for it but they managed to get a couple of dose later it was two weeks after he was sent to hospice. she said get out of bed. your tumor has disappeared. these are pictures of what happened to jason's tumor after he was sent home to hospice 15 pounds doubling every few weeks completely immobilized, immobilized, you
get the picture a literal and proverbial. this is where i say i'm good buddies, i am a health and science reporter, forgive my language what in the hell just happened? i asked myself. not only what is immunotherapy as people had begun to write about that but what is the immune system? what is this thing inside of us how have we got in to the point where we tinker with it? so just briefly cancer is one of the world's leading killers it isn't a cancer story or heart disease or respiratory disease alzheimer's diabetes
flu and pneumonia and kidney disease, stroke, hiv or diabetes. this is what kills us. this is not the story of any particular disease or injury but all of them in that extraordinary length that binds them. with all of human health and wellness this is the story of the immune system. an account of the remarkable discovery particularly over the last 70 years in the role this system plays in every facet of our health. i was going to read more but you get the picture. this is the system that defines health, longevity, wellnes health, longevity, wellness, weg and happiness. for the next couple years, i went and destroyed every misconception i had built up
over the system that is inside of us. i began with the most basic ide idea, even married to a doctor i want to tell you is a wonderful educator in her family, i totally listen to all of it. no laughter. [laughter] i totally listen to everything she says, but nonetheless i have a lot of misconceptions we had discovered that we share. note to self read, keep going, i began with the misconception the immune system was this zealous force to keep everything out of our bodies to do harm and to some
extent it serves that purpose. but the most basic thing that i learned i have since thought of in the context of the movie the matrix. remember? i will give stuff away. i cannot put an image here because of the lawsuit but remember all the ones and zeros and then he realizes he is surrounded by a world unseen to many of us? the most essential basic thing i learned about the immune system is predicate to explain how to it works we are surrounded by an invisible world at this moment on the surface chairs, jackets, shoes.
bacteria, virus, parasites, and myriad organisms ones and zeros of life and this principle is so essential to explain immune system because if it had been the way that i conceptualized it when i began my journey to attack everything alien, we would have scorched earth and nuclear winter. in fact,, the immune system is quite different than i conceptualized and what i want to begin with because this will help me hold that thought. don't pay attention. really what the immune system is is a calibration device aimed at assessing how to get along in the world in the least violent way possible. what it tries to do is
cooperate with all the ones and zeros and bacteria and parasites that surround us water, food to be as cooperative and harmonious as humanly possible. because if you must dole out violence or go to war, come on you can come through. waved to the cameras. you are adorable. [laughter] when you must go to war and act as a police state the violence is so pronounced and profound it is more dangerous than almost any passage you will encounter. so the immune system is the love child of a bouncer and a ballet dancer. it has immense power to spy and look inside your body and do terrific damage but it
tries to do so treading as lightly as possible. so i want to tell you a little bit about the other characters in the book. in order to describe this massive system i can do it justice in 15 minutes i hope the book does i felt i needed not only to bring in jason as a single perspective, but the perspective he lends to this story is one where the immune system was insufficient. it could not rise to the challenge to fight the cancer. that is only part of the conversation. i mentioned it can get out of whack very easy to hold itself in check but when it does not
we run into characters like meredith and linda whose immune system was insufficient women characters in the book if you prefer goldilocks metaphor there's was too much. each of the women profiled in the book suffer from autoimmune disorder. their stories are both harrowing and commonplace. i was unaware until i got into this book and got older and began to see what people around me were suffering with autoimmune disorder how prevalent this is. more than it has ever been because we are aging but in particular far more prevalent in women than in men at a topic i go to in the book.
i am really struck you can ask me at the time but why women are more susceptible to autoimmune disorder but i was struck by how much women have suffered in particular that men have been invisible historically. i seek to bring light to that topic how autoimmune disorders happen but why they feel so invisible. this is how they were, brought these up for a couple of reasons this is a woodcutting who was deemed hysterical remember we heard it was in your head? it is extremely excruciating to go to a doctor and the doctor say there is nothing inside of you alien causing
this therefore it is in your head. that does not in this case just because it is a visible doesn't make it any less real your body is attacking itself. this is a public notice in search of a werewolf. the first named rheumatoid condition was lupus. people thought you were disfigured from the bite of a werewolf. jason, immune system did not work enough these women it was overpowering. this is what linda's hand looks like even now she was a professional golfer she is fairly well remission this is why her hand can look like on a typical day from
inflammation. so the last character i chose in the book is the most marvelous one with too little and too much you are looking at a man with an extraordinary immune system. so extraordinary that the national institutes of health study it to understand why it is so perfect. what is the evidence? halloween night 1977 he was infected with hiv. later he did the forensics to support that he never had the symptoms or aids he is the elite controller and does something very few human beings are able to do is one
of the most devastating plagues that has hit humankind. it is devastating because that attacks the immune system with the retrovirus that is so nasty and mean and mutates and it kills and kills he has buried so many people this is bob who was with us today he is with his husband he teaches us a lot about the immune system. so i mentioned what the immune system is with this act of balance. to bring you some characters i want to tell you maybe the
most astounding question that struck me was so profound about the immune system is this. as it goes to strike balance with the world how in the heck can be prepared to face the myriad of different threats it may confront in the living world? believe it or not the immune system that you carry in you is pick your belief system, scientific, divine no less than miraculous because it has an answer to the following problem.
do you see how handy these are? and they are big. a huge challenge is the immune system faces are highly variable bacteria and viruses replicate very quickly bacteria can replicate every 20 or 30 minutes some viruses are faster each reproduction is opportunity for a change or mutation moving genetic sequences to turn a virus or bacteria that are body has figure how to fight into a bot virus or bacteria we do not know how to defend herself against. the human reproductive cycle gives rise to a new generation every 20 years. we cannot possibly survive an arms race of organisms that change at such a rapid pace. the bacteria can divide so quickly that if left unchecked it could take over our entire
body within four days. our own souls divide slowly to create about 16 new ones from each cell on a given day. math works against us. how could it be a single human body could be prepared to deal with so many threats including ones that might not even exist yet? our immune system need to cope with rapidfire mutations from pathogens or from a life form from outer space. this conundrum is amplified by simple math. we have a limited number of genes and in the 1970s that was thought to be around 100,000 in the human genome now we have learned smaller
perhaps 19000 or 20000. how can we possibly defend ourselves? he had two options he could turn into 10-foot tall pimples or give us the power to fight with different pathogens why pimples? they are filled with white blood cells that are made up of immune cells so clearly unless you are between 14 years old as one large pimple. [laughter] so in this case he favors a divine explanation evolution found a different solution. you have to read the book but it is quite marvelous with the immune system dies unlike any other genetic material in our body to be prepared to face almost an infinite number of
solutions. once the immune system is developed in a way to recognize a whole bunch of different opportunities the next thing that happens is a myriad of cells and molecules that have extraordinary specialized functions the b cell and the t cell just to give a sense of how recently we argued 40 or 50 years ago nobel prize winner in their discovery said when he told them about the t cell or the b cell that's not the immune
system those of the first and last letters but the extraordinary depth these are the transmitters that make the internet look like the slowest communication system ever existed a fever signal can go through your body. i make an attempt to take you a little deeper that are essential terms i try to hope and to define them but i want to give you one that teddy said earlier that the only
thing i had to apologize for occasionally i would write a peptalk to stay with me and she stuck with me and it was okay. but one of the hardest parts is the vocabulary. you will discover a bunch of vocabulary i tried to define it perk all of these terms represent incredible functions what your body is doing at the subconscious level to protect you. should you pick your nose? we will come back to this. i want to end and we will pause for some questions.
i realize i have covered a lot of ground to give you an overview about the book but the reality is the immune system is complex it would be hard to do justice without keeping here you longer than you would like to stay. also just a couple of concrete solutions and i will highlight two of them the nose picking piece and the stress piece and then we can have some questions anything you want to ask if i am aware i will tell you and if not i will defer to somebody in the audience. should you pick your nose? what i discovered with an article i wrote a few weeks ago about the hygiene hypothesis. it is aptly aimed but what
researchers have realized returning to the image of the ones and zeros our immune system benefits enormously by interacting with those viruses and bacteria and parasites most would do no harm. many would live with us in oculus lee if you would do harm but in each case the immune system learns and goes to boot camp to interact with the natural world. for a while this was thought of as the hygiene hypothesis that people who weren't overly hygienic circumstances overly sanitized environments got more allergies. but it turns out the hygiene hypothesis has been expanded a little bit with the old friends mechanism.
when we sanitize our environment we are blocking the problematic pathogens but also the friendly were other microbes to help inform our immune system. should you pick your nose? i asked the question of a couple immunologist for this reason not to justify my behavior. [laughter] in all seriousness, i believe watching my children and other children and adults there is a frequent urge to scratch in this area of the face. i ask scientist could that conceivably be a part of an evolutionary biological approach to your immune system? one very well healed said we
need to study that question we have taken it for granted because that represented the input of obnoxious pathogens so it could be an open question so the book outlines is isn't eat seller real never have a problem or put an avocado on your head. gets into the more basic science of the principles to underlie solutions there are for listed here but i want to highlight one because it's worth to put a fine point on it in the day and age of where we live and with stress. stress has an immediate and profound effect on your health through your immune system. to understand, picture
yourself in the savanna , 100,000 years ago. you are running from a lie in and in that moment your body is doing resource shifting shifting the resources to acute survival and away from some of the immune functions that are essential to your everyday health and so essential around the clock because if you have to survive a lion the head cold can wait. but in modern society we are blessed in this version of society we are not typically facing lyons or anything tantamount we face a lot of threats but on a biological and visceral level as potent
and as threatening as a lion but there is no lien but your body is shifting resources away from your immune system. last week this but came out and launched with a intense hour on npr and radio and obligations very quickly i got the stomach flu which i'm just coming out of. no surprise perk i know all the rules. i had to rest i had to nap more than usual. [laughter] thank you for not lift one - - laughing the sleep and stress chapters play together very deeply and that adrenaline has a direct effect on your immune system if you don't sleep you don't turn off those adrenal signals off either. i also want to emphasize
another big key take away. if you read something that tells you to boost your immune system look at it like this. for your version of that look do not view - - you wants to support the immune system not boost it boosted is dis- regulated joint pain and fatigue and fever and exhaustion. really think twice for no good reason in modern society. also i will not tell you how the story ended with jason and it was dramatic but one of the things immune system teaches us is that we are not meant to live forever. it is a system aimed at not
preserving the individual but the species. that is an enormous revelation but in its own way while protecting us from a certain period of time it will give us death for the sake of the species. this is an elegant defense thank you for listening. [applause] . >> i don't know if you did the effect of emotions or trauma or was that stress more specifically or trauma that
has not been dealt with to manifest itself? . >> do you kids want to sit here? the question is the impact of stress or specifically trauma on the immune system. i will be cautious and not speak to directly. i don't know about trauma per se but that can lead to things like anxiety and depression that you have a very direct effect on the immune system and sleep. i would suspect they are linked. when people are lonely immune system is troubled when they are troubled immune system goes into dysregulation.
one quick study. there has been some terrific studies done around stress and test taking with finals and herpes. you know, how herpes works? it is a nasty and beautiful virus in its relationship to the immune system. the epstein-barr virus that we most collectively carry and it can be held in check at the ganglia at the brainstem. the cell bodies at those nerve roots but those that crawl down into your mouth when you are stressed or traumatized or depressed they are held in
check by a healthy immune system. when the immune system weaken weakens, quite literally the herpes crawls down into your mouth. what researchers have noticed testtakers when they got stressed and herpes would manifest that lonelier students had a harder time. there is some evidence. you would know better because of the psychotherapy but it connects to depression and anxiety and loneliness i could testify to. >> and the connection to autoimmune diseases? . >> they are only starting to look at the connection between autoimmune disorder and how it connects to those issues that you are describing.
if only begin to understand those immune disorders themselves the cause and effect. >> are there other questions i cannot answer? . >> what is the relationship? . >> i can give you some of this from a guy sitting two behind you a friend and tennis buddy of mine and made a suggestion to a guy at caltech who helped me to understand the main character of this subject. for the micro biome is the
biosphere of bacteria living inside of you in your got half of the body cells are bacteria popularly in your gut. we are not at war with most of the bacteria around us. we know the bacteria don't want to do any harm to us we are there hotel, tent, youth hostel. we are their home and they want to cooperate with us. but a word of caution about the micro biome. micro biome research i could fairly say the most embryonic research of any field that will blow up into the extraordinary. it has the potential to tell us as much as we have ever known about human health for
go think of the collection of organisms in your gut all mixed together millions of cells, keeping apart is exceedingly hard. somebody tells you they know the answer to the micro biome question, they are not telling you the truth. but this guy at caltech can tell you speak up we can hear you. here is one of my favorite bits of trivia where researchers have discovered the micro biome once the body to live perk a remember the immune system has a terribly difficult task to deal with all the pathogens and microbes but it turns out the micro
biome is sending signals across your gut lining we thought was so sealed we call it immune privileged that nothing got in or out bacterial cells till your immune system. to instruct the cells in your immune system to ramp up or slow down. that is the basic answer to your question. there is a relationship but it will be exceedingly important one - - potent and a healthy got in your immune system and the river that runs through it. remember i said it is sending signals that say attach? or stop?
i just want to make clear this conversation, a big part of the molecules in your immune system are designed to put the brakes on the behalf are designed to stop it. we would not be here today without the immune system to put the brakes on. 's for mac i have a bad immune system. on the one that always get sick. [laughter] i understand exactly where you're coming from but is there anything that actually would do that or are there some people that are already behind so let's set aside that
which we know very little. i have had the world's arguably leading immunologist whose name is tony fauci who ran the issue runs immunology at the nih i would not have known his name before this started but if i say his name in almost any kind of researcher they fall down as if it was springsteen. [laughter] have you heard of springsteen? [laughter] he would tell me before a direct answer question we don't even know what to tell you what to eat or not eat or
what specific things to power your immune system. we are not at that point of specificity yet. but there are things that will boost your immune system that is extraordinary and dangerous. the reason jason returned from the grave nine toes in because he took a drug that unleashed his immune system. here has how cancer has been traditionally fought. we try to fight the pathogen the mutation itself. by putting toxins into the body, chemotherapy is aptly named throwing agent orange into your body i hate to say that because i know there are people here who have gone through it. it is not a delicate way to describe a horrific process.
that what is new the way we try to fight cancer goes to the question that you asked can we boost the immune system? the way we think about it now rather than attacking the tumor with toxins could we actually cause immune system to do what it was built to do in the first place? take the brakes off so that it attacks the tumor as intended? that is beginning to work in untold ways. the winner of the nobel this year was james allison from berkeley that when he discovered if you give a certain kind of molecule to a mouse and now to a human, now i will oversimplify that you can cause them to attack which
they had not attacked before some adjacent case the brakes were put on the immune system. the drugs camp or the brakes off and boost to the immune system and it comes with tremendous risk. if you boost that you invite all the things that can happen with an overzealous police state. . >> there are some therapies over a particular tumor they will find the mechanics that would attack it but insufficiently so and will amplify that. is that the mechanism we will be seeing as the new therapeutic model for the future? . >> i think the models will take as many shapes as there are innovators in creative medical people. what you are describing is a
combination of personalized medicine to understand the individual and his or her relationship to the disease. once a patient who was cured of hiv but also is not more important but more fundamental we are beginning to see these molecules and what they do and to tease apart here is a t cell or immune cell and what we know in general if it does this in this note is blocked can we monkey with that relationship between this note and tumor cell specifically? one of the challenges is there are not a lot of economies of scale.
friends of mine are in the business those are the solutions people were trying to solve. can we make this economical on a more personalized level? on a broad-based level or to boost the immune system or with autoimmune disorders we now put the brakes on the immune system in the same way but when you do that you and fight infection and the troubles that come along. the more precise we get that will happen. >> how has your own behavior changed? . >> if you have might have changed for quite new about the things i mentioned like sleep and nutrition and stress. i have become more habit driven. quite literally i can watch
the one / one relationship that i know is going on in my body and the science that backs up why that is happening. actually i am less germinal phobic both me and my wife and one of the reasons is because training of the immune system but i also realize frankly having a periodic head cold or the flu is not that bad for you. a case can be made for quite realize you don't have time to be sick but a case can be made some illness is part of health it's easy to say intellectually but hard to accept in the moment but the other place where my habits are most concrete is the handling of raw meat. i understand this to be part
of a really heavy area of possible transmission a higher concentration of pathogens than you would otherwise face in any other environment. in our kitchen cooking with meat or poultry looks like infection control. i do this a lot turning on the sink, i am being careful to wipe down the counters. that has to do with the series that will launch shortly in "the new york times" that i oversaw last year dealing with drug-resistant infections but i would encourage hygiene around raw meat it is simple but it is true. he does do it a lot says my son. my wife laughs at me. [laughter]
. >> i have a question over biologic priority. the body does things in an order that it knows will sustain it. the immune system under ordinary circumstances has a very high biological priority and the idea that seems to be so prevalent in our society that you said i will go to john the juice for immune boosting that probably isn't at all. people are so credulous that food has everything to do if you do this or the other brick you could start for six months but your immune system has a high biologic priority so it will give up other stuff. >> can i speak to your point?
she makes a good interesting point about how credulous we are around certain ideas. i have thought about this a bunch and for instance we got to the point we put goop all over ourselves anytime somebody touches a banister and why we are so worried about that. a lot of our habits around health derived from a natural and understandable place. i looked for a quotation in exodus about ritual handwashing. goodbye eric. good to see you. eric is in the book for that we should honor him. you can see in multiple religions and cultures how we
handle meat and some don't eat beef or pork look at many practices born out of a very understandable lack of control over an environment that not only did we not control but did not understand. in the period that we find ourselves in as a fertile ground as a generalist to educate where we not only learned to over correct think of the industrialized process has come about for good and understandable reasons for your processed food but we have seen the side effect of obesity it is requiring reorientation of the new set
of facts it is understandable for many years we believe the reason we were getting sick is because immune system was not strong enough. the way you might look at the sky and make assumptions where the stars are. the more we learn the more we learn. one of the beauties of the age we have a chance to correct where we overcorrected. that is a more nuanced relationship with the world around us. economic forces get invested in marketing messages that have worked. and example is antibiotic that is vastly overused by about 30 percent.
but they were so effective for a long time because when those economic forces get involved and they give a message it's hard to undo that. . >> it is like probiotics they don't ask you if you and should not but which you should take. and we can improve our memory from an extract of jellyfish. i don't know if they have a nervous system. [laughter] i am a pharmacist so people say i don't want to take drugs so they come up with a farm load of supplements they have no idea what is in it for good everything is a chemical. i don't want chemicals in my body. . >> one other area for those
who cannot hear those who buy supplements from madison avenue with the incredible disconnect so whatever you believe about marijuana but the fact it is sold as mere loan - - medical marijuana there is almost no research except three very specific areas with control studies. it is an extraordinary notion to think about. and to question and comment.
fixing and killing and rebuilding and destroying infection and rebuilding new tissue and then there's the adaptive immune system and its builduit'sboth of those very sod cells that are precise in being connected to molecular lay the very infection if you are facing someone is generic and one is precise. here's the problem with the system it takes time to generate activity. first what happens is the body must decide what is the nature of the thing i am confronting and then it must find the proper so. the majesty of this is
extraordinary but i just want to say this, it takes time. when you are facing very dangerous pathogens, smallpox, polio, other things you do not want to wait the five to seven to ten days building a blueprint for that factory before you ever faced the deadly pathogen it's not just your child's life at risk, it's other children in those classes who could be at risk if people stop taking vaccines. >> anything else? i just want to thank you guys we had the great privilege of
having booktv thank you c-span for coming. i'm going to sign some books and otherwise were regardless have a great night and thank you very much. next on booktv "after words" investigative journalist vicki reports on the career of jared and ivanka trump interviewed by elizabeth spires. "after words" is a weekly program with relevant guest hosts interviewing top nonfiction authors about their latest works. >> i'm here with vicky ward, the author of kushner inc.. it's great to have you here today and i'm very curious to know your thoughts as