Survival of the Sickest: A Medical Maverick Discovers Why We Need Disease
by Sharon Moalem, Jonathan Prince
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Book Summary Information
Author: Jonathan Prince, Sharon MoalemEdition: Hardcover
Audio: English (Original Language); English (Unknown); English (Published)
Published: 2007-02-01
ISBN: 0060889659
Number of pages: 288
Publisher: William Morrow
Book Reviews of Survival of the Sickest: A Medical Maverick Discovers Why We Need Disease
Book Review: A Medical Freakonomics
Summary: 5 Stars
We're used to thinking of disease as the enemy, as a malicious force that makes our lives shorter and more miserable. That may be exactly what "disease" is on an individual basis--but its value to the species as a whole is a different matter.
Dr. Moalem elegantly explains why medical conditions that are deemed to be diseases today often helped our ancestors survive and reproduce in difficult environments. Take hemochromatosis, a hereditary condition that causes iron to accumulate in a person's internal organs, eventually leading to death. Although the gene that causes hemochromatosis was once thought to be rare, research completed in 1996 found that it's actually surprisingly common. Why wouldn't such a terrible disease have been "bred out" of our species long ago? The answer is that hemochromatosis reduces the amount of iron available to iron-loving bacteria, such as the bubonic plague that depopulated Europe in the mid-1300s. A person living in the Middle Ages with the hemochromatosis gene would have eventually died from iron build up, but in the meantime would have have had a smaller chance of dying from the plague and other iron-loving infections--in an age when few people lived past the age of 50, the disease resistance conferred by hemochromatosis far outweighed the disadvantage that would have materialized if the person carrying the gene had lived to old age. People with hemochromatosis reproduced and passed the gene one to their heirs; those without it died of the plague, without children.
"Survival of the Sickest" is filled with similarly surprising observations. Anemia may be the body's way of reducing iron available to bacteria--giving an iron supplement to a malnourished population may be a bad idea and ironically (so to speak) medical bloodletting may not have been such a bad idea. Type II diabetes may have been a condition that conferred an advantage on northern Eurpoeans during the ice age, when an increase in sugar in the bloodstream and frequent urination would have reduced the risk of freezing to death. Similarly, sickle cell anemia offers protection from malaria. In the "good old days," a genetic condition that kept a person from dying before reproducing would have been a boon, even if the condition would have turned killer if the person managed to reach old age.
The book is filled with other "big ideas, briefly discussed." Instead of battling bacteria with antibiotics (which is only making them tougher), perhaps we could manage their evolution so that they thrive by inconveniencing their host (like a cold) instead of by flooring it (like malaria). And, although Dr. Moalem seems to agree that natural selection is the big driver of evolution, he observes that perhaps Lamarck wasn't so far off after all--jumping genes, retroviruses and methylation all suggest that an organism's life experiences can in certain circumstances affect future generations. As for aging--perhaps our bodies are designed by natural selection to limit the number of times a cell can reproduce (thus insuring that we will all die from old age if something else doesn't get us first), the alternative being an excess of cells without such a limit (in other words, cancer).
On the whole, "Survival of the Sickest" is readable, surprising and filled with "ah-ha!" moments. If you enjoyed "The Tipping Point" or "Freakonomics," you'll probably be intrigued by Dr. Maolem's often counter-intuitive observations.
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