About book Why We Get Sick: The New Science Of Darwinian Medicine (1996)
The title and physical design of this book gave me the initial impression that this book was fluff. "The New Science" made it sound, frankly, like pseudoscience. The impression of pseudoscience (perhaps I was alone in that first impression) does the book a disservice, however; the book is not pseudoscience fluff. In technical terms, it is some damn good stuff. Randolph Nesse is a biomedical doctor well-known and respected in the academic community. Williams is an evolutionary Anthropologist and biologist (or rather, he was; he died a few years ago). Anyway, that's beside the point; the point is, these two authors know their stuff and the book benefits from their holistic research backgrounds. "Why We Get Sick" is an interesting title, since the question plagues each chapter. Evolutionary medicine concerns the "why" questions of medicine and health, as opposed to the "what" or "how" questions focused on in regular medical practice. Evolutionary medicine tries to put health in an evolutionary context, and humans in relation to their evolutionary past; all wonderfully worthy goals. Yet, the problem with this approach is that there is simply too much we don't know; evolutionary medicinal research constantly tries to bring theorizing into the realm of testability, and often fails.Hence, the greatest strength of this book is actually its greatest weakness. Nesse & Williams know their shit, yet because of that, they are hesitant to actually provide firm claims to knowledge. This is a good thing! But, it also brings the title of the book into question. Why do we get sick? answer: we're still working on that, but in the meantime there has been a lot of cool and interesting research that provides clues. If you go into this book expecting hard answers, you will be disappointed; however, if you go into the book expecting interesting questions and thought-provoking clues about how medicine relates to the humans as evolutionary animals, then you will be very pleased. This book makes a wonderful introduction into the world of evolutionary medicine, and would be a great companion book to something like Evolutionary Medicine, A Planet of Viruses, or Parasite Rex (with a New Epilogue): Inside the Bizarre World of Nature's Most Dangerous Creatures. We like to study history because the past can give us clues about the future; bio-medicine is no different, and looking into the human evolutionary past can provide wonderful clues about the human future.
I enjoyed every second spent reading this book! In summary, Darwinian Medicine proposes that descriptions of disease in current medical textbooks omit the importance of an evolutionary explanation for why humans are vulnerable to this disease. These explanations will have immediate practical benefits for medical practice. General physicians still don't think of fever as useful and they still give iron supplements to patients with chronic infections, perhaps letting the fever run its course without treatment is better for the patient.. Infectious disease specialists still think that pathogens have evolved to benign co-existence in our environment. Psychiatrists still believe that anxiety, sadness, and jealousy is abnormal and they try to treat the problem rather than research the selective advantages of genes that predispose to schizophrenia and bipolar disorder. Rheumatologists don't know that the high uric acid levels of gout may have been selected to slow aging and they prescribe anti-inflammatory agents that may hasten hip degeneration. Obstetricians have not considered the possibility that nausea of pregnancy may be a defense against toxins. The research on weather evolutionary standpoint to better understand genes and disease will be profoundly grateful when dealing with the prevalence in disease.
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Worth a read. The authors argue for the value of an evolutionary perspective to better understand disease processes and health vulnerability, rather than just looking at the "proximate" causes (the usual medical model). They do a good job of showing how "evolution" is generally misunderstood by lay people to mean some kind of advancing perfectionism of the body, when it is more like a process of kluging stuff together in a way that guarantees genetic survival. They also do a good job of showing how we and all forms of life are engaged in a sort of war for survival with each other. They also do a very good job of explaining how evolution is not much related to longevity, that in fact many things that have survival value in youth become problematic for us as we age. Much of what is presented is just speculation but that's ok because the books purpose is to promote more research designed to answer questions about how evolution impacts health.
—Sandra
My only qualm with the book is that it starts off acknowledging that evolution is only a paradigm and not the ultimate truth, but ends stating that biology only makes sense with an evolutionary perspective.But how well the authors explain so much! They continuously call for more research on this or that, and offer a fair amount of speculation. But it's always quite clear when they are explaining fact, theory, or speculation. Make up your own mind - their explanations are awfully coherent and scientific. No science background needed - dig in and learn.And in case you don't read it, know this: meat manufacturers habitually pump antibodies into their animals in order to keep them healthy. Unfortunately, when we consume them, it gives bacteria and viruses a head start on making counters to these antibodies, so when we do get sick, and go to the doctor, the antibodies we get won't do us no good. Of course, this falls somewhere between fact and speculation.
—james
The style of the book was spot-on. There are many essay-style parts which make up the chapters. The book itself served as a medium for asking questions and often posed many of its own. An overall nice take of the evolutionary perspective especially when it comes to how we tend to view symptoms (defenses) as well as some nice tie-ins to psychology. I feel that although some of this is becoming dated as the thinking being suggested is now finding its way into curriculum, epigenetics now offering some supportive insight, etc, this remains a great book for the first year college student who is approaching any of the sciences (hard or soft). I truly liked this book and believe it provides a useful perspective. In addition,this book will serve up some solid critical thinking discussions in a classroom.
—Joe Iacovino
