Why We Get Sick: The New Science of Darwinian Medicine

Applying the principles of evolutionary biology to the problems of medicine, an innovative approach to the medical field explores the reasons why people get sick, answering provocative questions about aging, obesity, cancer, infection, and death. 20,000 first printing.

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.

Offering new insights on the failure of evolution to eradicate disease, psychiatrist Nesse and ecologist Williams offer numerous suggestions on why certain seemingly negative traits have not been eliminated through natural selection. A brief discussion of the basics of evolution is provided, along with examples of how the theory of natural selection may relate to aging, cancer, allergies, and other diseases. One particularly intriguing chapter is devoted to the possibility of an evolutionary contribution to psychological disorders such as excessive anxiety or depression. Marc Lappe's recent Evolutionary Medicine: Rethinking the Origins of Disease (LJ 10/15/94) conveys a similar message on the increasing need to consider evolutionary principles in the treatment of disease. Both books are thought-provoking and worthy purchases, but librarians interested in a slightly less technical narrative may prefer Why We Get Sick.
Tina Neville, Univ. of South Florida at St. Petersburg Lib.
Copyright 1995 Reed Business Information, Inc.

Although they realize that evolution selects not for health but for reproductive success, the Darwinian physicians of Nesse and Williams' trope see the body as "a bundle of careful compromises." These Darwinians also see trouble-causing genes as those that combine good and bad features because they have not adapted completely from their Stone Age purposes to the diverse demands of today's environment and ways of living. Physicians should look for the evolutionary, not the proximate, causes of disease, Darwinians say. For example, the gene that causes sickle-cell anemia, which is most often seen in malaria-ridden areas, actually protects the individual who has it from malaria (and now, apart from in areas endangered by malaria, this gene is decreasing in frequency). When physicians look at allergy, cancer, even mental diseases, through Darwinian eyes they see and, Nesse and Williams say, will increasingly see medical problems in a new and thought-provoking light. Why We Get Sick deserves pondering by both physicians and laypersons. William Beatty