Why We Get Sick: The New Science of Darwinian Medicine [Paperback]

Randolph M. Nesse (Author), George C. Williams (Author)

Book Description

Release date: January 30, 1996

The answers are in this groundbreaking book by two founders of the emerging science of Darwinian medicine, who deftly synthesize the latest research on disorders ranging from allergies to Alzheimer's and from cancer to Huntington's chorea. Why We Get Sick compels readers to reexamine the age-old attitudes toward sickness. Line drawings.

Editorial Reviews

Amazon.com Review

Is our tendency to "fix" our bodies with medicine keeping them from working exactly as they're supposed to? Two pioneers of the emerging science of Darwinian medicine argue that illness is part and parcel of the evolutionary system and as such, may be helping us to evolve towards better adaptation to our environment.

From Publishers Weekly

Nesse and Williams have written a lively discourse on the application of the principles of evolutionary biology to the dilemmas of modern medicine. Nesse, a physician and an associate professor of psychiatry, and Williams, a professor of ecology and evolution, provide a primer on Darwin's theory of natural selection. They explain that the functional design of organisms-e.g., our bodies-may suggest new ways of addressing illness. The book begins with a look at the causes of disease and their evolutionary influences. But the book mainly assesses the concept of adaptation by natural selection, and illustrates the ways Darwinian thinking can be applied to medical problems. As one example, the authors examine the use of penicillin over the past 60 years against bacterial infections. The book's quirky information may speak to a broad audience: researchers, for instance, have found that relatives of schizophrenics have an unusually high frequency of inclusion in Who's Who-which may counterbalance drawbacks of the disorder in evolutionary terms. The tendency toward child abuse, too, may be influenced, the authors say, by evolution and the passing on of genes. And there may well be an evolutionary reason to welcome morning sickness, they argue: nausea and food aversions during pregnancy apparently evolved to impose dietary restrictions on the mother so as to correspond with fetal vulnerability and, thereby, minimize fetal exposure to food toxins.
Copyright 1994 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 304 pages
• Publisher: Vintage; 1 edition (January 30, 1996)
• Language: English
• ISBN-10: 0679746749
• ISBN-13: 978-0679746744
• Product Dimensions: 5 x 0.6 x 8 inches
• Shipping Weight: 9.1 ounces (View shipping rates and policies)
• Average Customer Review: 4.3 out of 5 stars  See all reviews (35 customer reviews)
• Amazon Best Sellers Rank: #30,628 in Books (See Top 100 in Books)

Most Helpful Customer Reviews

111 of 114 people found the following review helpful

4.0 out of 5 stars Readable introduction to the ideas of evolutionary medicine July 16, 2001

By Dennis Littrell HALL OF FAMETOP 500 REVIEWERVINE™ VOICE

Format:Paperback

This is a very readable book and an excellent introduction to a subject that has hitherto been sorely neglected. The main argument presented by Nesse and Williams is that disease must be understood from the perspective of evolutionary biology.

The authors begin by asking, "Why, in a body of such exquisite design, are there a thousand flaws and frailties that make us vulnerable to disease?" Through evidence and insights from evolutionary biology, the authors carefully give a detailed answer to this question, which might be summed up thus: The mechanism of evolution fits our bodies for reproduction, not for optimum health. Furthermore the mechanism is imperfect and subject to mutation. Additionally we are in competition with other organisms, e.g, viruses, bacteria, etc., that work toward their fitness, sometimes at our expense (the parasite-prey "arms race"). Noteworthy is the idea that natural selection cares little for the maintenance of the organism after the age of reproduction, and that sexual reproduction actually fosters mechanisms that increase the fitness of youth while neglecting the aged, leading to the phenomena of senescence and death.

Seeing disease from the viewpoint of evolution, the authors argue, helps us to understand disease and the mechanisms involved, which in turn can help us to fight disease. Allergy, for example, is a disease characterized by an over active immune system. Copious amounts of histamine are produced to fight off a few molecules of pollen. Why? The authors make the point that our immune systems operate on the principle that better an overreaction to something harmless than an under reaction to a real threat. It's like jumping at the sight of a piece of rope lying on the ground. It's not a snake, but better this little harmless error than being too slow to get back from the real thing.

Some other interesting ideas: Fever has a purpose. It raises body temperature enough to interfere with the chemistry of some pathogens, thereby killing them. If we take medicines that reduce fever, are we prolonging our illness? In some cases, the authors answer, yes. If we take medicines that suppress coughs and sneezing can that also prolong our illness? Again the answer is in some cases, yes. The point is that in treating the symptoms of disease we need to make a distinction between which are defensive mechanism of our bodies and which are not. Some pathogens, for example, make us sneeze or cause diarrhea in order to better spread themselves to the next victim. The rabies virus makes a dog bite other animals in order to spread itself. But our bodies cause us to cough and sneeze primarily to expel pathogens.

The authors see some of our health problems as the result of genetic "quirks," or evolutionary hangovers. Dyslexia is an example. In the Environment of Evolutionary Adaptation back in the Stone Age, dyslexia was no problem because there were no books to read. Indeed, it might be that the dyslexic approach to some perception problems, is better than the "normal" one, allowing a quicker, better understanding of the objects being viewed. Other genetic quirks include our predisposition to eat too much fat when available because in the EEA there was precious little fat to be had so it made sense to eat as much as possible when it was available. Something similar can be said of alcohol. Before agriculture, and especially before the process of distillation, a predisposition to alcoholism was no danger because there was very little alcohol to be had. These "quirks" are examples of disease caused by "novel environments," much of the modern world being a novel environment to our Stone Age bodies.

Nesse and Williams show that the modern environment, which requires a lot of close work from all of us, especially the reading of books, is the cause of the epidemic of myopia that modern humans experience. I would like to add that it is possible that myopia under some conditions could be adaptive. In the rainforest it would probably be better to see well close at hand than far away (the opposite of what would be valuable on the savannah). Also those people who concentrated on things small and up close might well identify and process food sources overlooked by others.

While this is an excellent book, gracefully written and full of valuable information and insight, it is now a little dated (copyright 1994), and some of the ideas need reworking in light of recent discoveries. For example, while the authors discuss the ill effects of too much fat and sugar in our diets, they say nothing about the carbohydrate intolerance that leads to obesity. This too can be seen as an evolutionary quirk since there were no cultivated fields of amber grain in the prehistory, and the grains that were available were small and required a lot of hand processing so that it was very difficult to overindulge. Consequently there was no need for natural selection to evolve a protection against eating too much. Also their discussion of heart disease and how it is the result of genetic factors and faulty diet fails to mention the idea that heart disease might be caused by a bacteria. (See for example, Plague Time: How Stealth Infections Cause Cancers, Heart Disease, and other Deadly Ailments (2000) by Paul W. Ewald.)

All things considered, though, this is a classic of evolutionary literature, nicely presented to a nonspecialist, but educated public. Now if we can only get the doctors to read it!

--Dennis Littrell, author of "Understanding Evolution and Ourselves"

26 of 26 people found the following review helpful

5.0 out of 5 stars An evolutionary approach to understanding medicine April 23, 2000

By Peter Gray

Format:Paperback

Slightly modifying an oft-quoted line by the famous biologist Dobzhansky, Nesse and Williams conclude, "After all, nothing in medicine makes sense except in the light of evolution." In this lucidly written book, the authors make this assertion throughout. They lay out principles for interpreting aspects of human health from an evolutionary perspective. For example, some of the body's responses can be viewed as adaptive defenses (e.g. fever), others the products of novel environments (e.g. Sudden Infant Death Syndrome, or SIDS). The authors raise intriguing examples, from adaptive withholding of the body's iron stores to pregnancy sickness, that put flesh on the bones of these principles. This book does a fine job of overviewing the ways in which an evolutionary perspective can contribute to a richer understanding of medicine than the more proximate (e.g. what are the chemical and genetic bases to schizophrenia?) focus alone can provide. For this reason, it may long be seen as a seminal contribution.

19 of 19 people found the following review helpful

4.0 out of 5 stars Stimulating Persepctives on Sickness March 15, 2002

By Daniel Chan

Format:Paperback

-Why We Get Sick- is a discussion on novel way of thinking about sickness, an epiphany on the perseverance of human vulnerability. The book addresses whre disease come from and why we get such diseases. Nesse and Williams carefully state 6 major causes of diseases: Defenses, infection, novel environments, genes, design compromises, and evolutionary legacies. Our immune system is the frontier battefield of any intruders. Studies have shown that at the first point of contraction, the immune system proliferate T-cells against the HIV virus. These immune cells fight the best they can to prohibit HIV settling onto the CD-4 cells. The only reason the immune system loses is because the HIV virus is simply too smart that they mutate into other forms and fool the T-cells. The first sign of the cold virus triggers series of defensive action-fever and sneezing are actually not illness, but defensive/immunological responses against the virus.

Bacteria can evolve as much in a day as we can in a thousand years, and this gives us a grossly unfair handicap in the arms race. That's right, according to the authors of this book, we are in an ever-lasting struggle with bacteria and virus because they evolve so much faster than we can imagine. TB disappeared more than 40 years ago after the discovery of antibiotics. TB is now coming back with an even more potent form-a kind that no longer can be treated by the old antibiotics. Evolution of the virus plays a significant role here. The possibile treatment would be chemical mimetics, synthesizing structurally similar compound to treat the new strain.

The more I read the more I'm refreshed by the authors. They discussed the cause of allergy and why some people are so allergic to plants and pollen while others are completely immune to them. The book also makes distinction between virus and toxins. How does the body identify novel toxins? What is the sinificance of maleness and femaleness? These are questions we all address but of which we never consider in the evolutionary point of view. The authors do not argue that evolution is the main cause of why we have allergy, AIDS, influenza and gene defects, but they have done a brilliant job in exploring the matter in this side of the argument.