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system that launches beautifully, but frays under its own
success.
Now, the real work begins. Not in blame, but in redesign.
Because biologics aren’t going away.
They are the future of medicine.
But if we want that future to be durable, equitable, and
trusted, we have to finish the work we started.
The immune rebellion isn’t science fiction. It’s already
here.
And in the chapters ahead, we’ll learn not just how to fight
it—but how to prevent it altogether.
2.10 Case Study: A Patient Lost in
the Protocol
A middle-aged man with a long history of inflammatory
bowel disease—moderate-to-severe Crohn’s—had finally
reached what his doctors called “deep remission.” After
years of flares, fatigue, hospitalizations, and prednisone
tapers, he had been placed on an anti-TNF biologic therapy.
The response was dramatic. Within weeks, his energy
returned, his inflammatory markers dropped, and for the
first time in nearly a decade, he started to plan for a future
that wasn’t defined by disease.
But the remission didn’t last.
By the end of year one, symptoms began to creep back. Not
all at once. Gradually. A flare here. An elevated CRP there.
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