Treacherous friends

Friendly Fire
November 3, 1995

The term friendly fire was much used after the Gulf war in descriptions of the substantial number of allied combatants shot at by their own side. I have always felt that this chirpy euphemism must grate horribly on the relatives of such victims of war. But David Isenberg and John Morrow use this aspect of the invidious military metaphor to draw attention to autoimmune diseases in which the immune system plays a major role in the pathology. Thus, rather than being the defender of the integrity of the individual from microbial infection, the immune system turns on its host, often with devastating consequences.

However, the description of autoimmune disease as "friendly fire" disguises the notion that the "attack" is treacherous and the disease therefore particularly malign.

The book offers a short introduction to immunology and tries to explain a range of immune phenomena. In this aspect Isenberg and Morrow are to be commended, but taken as a whole, they have tried to tackle too much in too short a space and they never really explain anything in any depth.

It is a short book of barely 130 pages of text divided into six chapters. The style is extremely familiar. Chapters have titles such as "What exactly is the immune system and what does it have to do with disease?" - which suggests that the authors are keen to cut through the jargon and tell you how it is. But of course it cannot be done, because any specialist subject depends upon its terminology to avoid imprecision or tedious and convoluted explanation. And so within a short time, the reader is inevitably introduced to an eclectic range of CD numbers and esoteric HLA nomenclature.

Each chapter is preceded by a boxed abstract and a useful glossary and index are appended. Two levels of subheadings within the chapters leave the majority of sections with just one or two sentences; this provides relatively easy access if you want to find something in particular, but is not conducive to easy reading. For the most part, the explanations are not controversial, though the reference to the 46 pairs of human chromosomes (23 is usual) having remarkable scope and influence is both banal and begs the question, influence on what?

At the risk of alerting the political correctness police to a new domain, I was disturbed to read at the end of chapter three, which tells us "What has to go wrong before an autoimmune disease develops", that on the whole, women patients with rheumatoid arthritis are more nervous, tense, worried and moody than their healthy female siblings. I think the authors mean "sisters" and I am puzzled as to who might do such research and why. Would any man with rheumatoid arthritis not be more nervous, tense, worried and moody than his healthy brothers, or sisters for that matter - and surely with good reason?

This is not an important book for immunologists, but in fairness it is not aimed at them. It may catch the eye of the interested general reader and in particular the many friends and relatives of patients who suffer from debilitating autoimmune diseases. Its appropriate format must be as a paperback where the price will not discourage too many people from buying it.

Richard Lake is a research fellow in immunology, Queen Elizabeth II Medical Centre, Perth, Western Australia.

Friendly Fire: Explaining Autoimmune Disease

Author - David Isenberg and John Morrow
ISBN - 0 19 262220 X
Publisher - Oxford University Press
Price - £17.99
Pages - 155

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