Why We Get Sick: The New Science of Darwinian Medicine (Paperback)

~ (Author), (Author) "Why, in a body of such exquisite design, are there a thousand flaws and frailties that make us vulnerable to disease?..." (more)
Key Phrases: genes that cause disease, novel toxins, genetic quirks, United States, University of California, University of Michigan (more...)

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: 8 x 5.1 x 0.9 inches
• Shipping Weight: 8 ounces (View shipping rates and policies)
• Average Customer Review: 4.4 out of 5 stars  See all reviews (24 customer reviews)
• Amazon.com Sales Rank: #27,425 in Books (See Bestsellers in Books)

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Most Helpful Customer Reviews

72 of 73 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 (SoCal) - See all my reviews (TOP 50 REVIEWER)    (REAL NAME)    (COMMUNITY FORUM 04)

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!

17 of 17 people found the following review helpful:

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

By	Peter Gray (Cambridge, MA United States) - See all my reviews

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.

12 of 12 people found the following review helpful:

4.0 out of 5 stars Why Evolution Is Important to Our Health, August 2, 2005

By	D. S. Heersink "D. Stephen Heersink" (San Francisco) - See all my reviews (TOP 1000 REVIEWER)    (REAL NAME)

Both authors are scientists of the highest caliber, and "Why We Get Sick" is a marvelous, important, and valuable read. The book's purpose is to include functional evolutionary explanations into ordinary medicine, a project that is only slowly coming to be. The key to unlocking so many mysteries behind so many diseases is to look beyond proximate causes and look instead for functional, often evolutionary, causes of disease and dysfunction. This requirement demands that we don't stop at signs and symptoms of disease, but that we understand how the disease disrupts the function of organisms. Only by a functional understanding of disease, which requires an evolutionary perspective, can we both prevent and treat disease more quickly, accurately, and thoroughly.

The classic case is fever. Hopefully, we all know that most fevers are generally good for us (to a degree), namely that it is the body's own defense mechanism to raise the body's temperature to help kill pathogens. Some fevers, obviously, need to be treated with aspirin, but by doing so, you may actually prolong the disease. If we understand that fevers play a vital evolutionary role in helping us ward off pathogens, we'll not want to reduce a fever unless absolutely necessary (e.g., very high temperatures). Our body's own immune system is a marvel of evolution at work; and we need to learn to work with it, not work around it, much less against it. Certainly we ought not be taking antibiotics for viral infections, yet patients demand it, and doctors give in. There are health consequences to this slipshod type of medicine.

If we understand, similarly, that being biped is relatively recent in our evolutionary history, and we understand how our visceral girdle is designed for quadrupeds, not bipeds, then the fact that so many of us get back pain should not come as a surprise. And, the more sedentary and unexercised this girdle becomes, the more prone to back disorders (e.g., herniated discs) we become. Part of the evolutionary scheme of things is preventative as well as curative, so rigorous exercise of our midriff girdle will do much to prevent back disorders resulting from flabby girdles. By taking the evolutionary function into account, we are better able to prevent as well as treat most disorders.

These are just two examples of a plethora of diseases that, when given their functional aetiology, give a fuller account of what steps are necessary to keep us healthy and which steps are necessary to treat illnesses. The authors maintain that we must get to the true, real, and functional cause of most disorders before we have a real grasp of disease itself, thereby opening the door to both conventional and evolutionary prevention and treatment. I can't possibly do justice to the depth and breadth of this very important work. While I believe it should be in every doctor's library (like "Darwinian Psychiatry" should be in every psychiatrist's library), it is also one book most health consumers need to understand. Some parts are challenging reading, but it's worth it.

I do have several criticisms. First, the book is not the finest in scientific writing for the layperson. Many doubly compound sentences (and subjects) would have been better developed with a shorter, simpler sentential writing style. Second, no footnotes; there are notes at the end of the text, and no bibliography. Third, the organization and presentation in the first part of the book could be better, with implications made explicit. These criticisms, while not major, do affect the overall rating of the book.