Survival of the Sickest: A Medical Maverick Discovers Why We Need Disease by Sharon Moalem

Survival of the Sickest: A Medical Maverick Discovers Why We Need Disease Reviews

• 
  Travis

  It was not a bad book and it was a quick read, but I was a little disappointed for two reasons.
  
  The first, not the authors fault, is that I didn't learn much new -- the general principles and ideas the author was articulating about biology, genetics, and evolution, were not really new to me, although some of his examples were new.
  
  The second was that I thought the author was playing a little too loose with facts. Even though the target audience was a popular audience, I don't think that is an excuse to make points that sound like certainties that are not. An example is his claim about sunglasses affecting the body's ability to protect against sunburn. It sounded plausible, but my own further reading on his claim shows that there is very little evidence to support it (in fact, it was really just speculation). In other cases, the author would go on about a particular hypothesis, and only just throw in at the end that, oh yea, scientists don't really know if this is true.
  
  In short, if you're not familiar with a lot of the latest research in evolution and genetics, the book may be an interesting read for you, just be careful not to give too much credence to any particular hypothesis expressed in the book.
• 
  Chris Keefe

  Very good.
  As I wrote to Dr. Moalem,
  
  Dear Dr. Moalem,
  I found your book, Survival of the Sickest, on a table in the bookstore that employs me. The title and concept intrigued me. The material has proved fascinating, and, for the large part, very well researched. I am concerned, though, with a statement you make on page 87, regarding psoralen production in organically grown celery. It reads,
  
  Farmers who use synthetic pesticides, while creating a whole host of other problems, are essentially protecting plants from attack. Organic farmers don’t use synthetic pesticides. So that means organic celery farmers are leaving their growing stalks vulnerable to attack by insects and fungi – and when those stalks are inevitably munched on, they respond by producing massive amounts of psoralen. By keeping poison off the plant, the organic celery farmer is all but guaranteeing a biological process that will end with lots of poison in the plant.
  
  Within these few sentences, whether by intent or by oversight, you perpetuate a very dangerous fallacy. Your subtext implies that organic farmers, because they choose not to use synthetic pesticides, fungicides, etc, are in some way failing to protect their plants, and in turn the consumers of their foods. The crucial word here is “synthetic.” Even glancing research into the nature of organic farming will yield a wealth of information on natural pest control. For example, using companion planting (e.g. garlic and marigolds protect crops planted near them), natural pest-prevention methods (e.g. ladybugs to manage aphids), and perhaps most importantly, effective crop rotations and management strategies, effective organic farmers are often capable of creating an environment or ecosystem that is simply less accessible to animal, fungal, and even microbial predators. With proper management, the system protects itself without the need for synthetic help.
  You might be interested to know that genetics play a strong hand here as well. Plant species, like the marigold, that have developed natural defenses have greatly multiplied their species’ success by harnessing the help of human agriculturalists. The flower helps the garden, the gardener breeds the flower. In the same way, the growth of corn provides structure for the growth of beans, and shade for the growth of squash. The beans fix nitrogen in the soil for use by the other plants, and the squash provides ground cover which minimizes weed growth. By carefully selecting the plants and animals he cultivates, and thereby manipulating the ecosystem he manages, an organic farmer uses naturally occurring genetic predispositions, in diet, toxicology, and even plant structure to the benefit of all of the partners in the system.
  On the other side of things, conventional industrial monocropping, and, admittedly, most organic industrial agriculture, bring their own inherent dangers to bear on the celery plant. Machine weeding, machine spraying, machine fertilization, and machine harvest, not to mention preparation, packaging, storage, and shipping, all tend to batter the plants. It is rare that I see conventionally grown, bagged, and shipped lettuce at my local supermarket without a chunk or two taken out of it somewhere during it’s trip from seed to shelf. I would hazard a guess (admittedly, an uneducated one) that at least the pre-mortem processes listed here drive psoralen production as strongly as the odd bug bite does.
  In looking through your notes and cited sources, your citations of two papers discussing adverse reactions to celery (with exposure to UV radiation) did catch my eye. Admittedly, I was not able to track down the second of the two articles. Unless its title fails to disclose its focus, though, it does not appear to concern itself with the “organic versus conventional” debate you spark with the throwaway comment quoted above. My apologies if my own failure to read your cited sources has provoked unmerited criticism, but your careless choice of words, and/or your failure to provide discussion of psoralen levels in organic and conventional produce lead me to find your “celery comment” reactionary, at best.
  Please, Dr. Moalem, take a deeper look into the subtext of your statement above before you decide to publish the next edition of your book. Even if there were data that implied higher psoralen levels in some organic celeries, your writing goes beyond this in discrediting the work of organic growers. You equate the use of highly toxic, environmentally and politically unsustainable synthetic pesticides with pest control. You then equate the use of any other system with a failure in pest control. To quote, “Organic farmers don’t use synthetic pesticides. So that means organic celery farmers are leaving their growing stalks vulnerable to attack by insects and fungi”.(Moalem 87,my italics) The logical fallacy here is one produced by not taking into account all of the variables present. You left this out: Organic farmers use effective alternative systems for managing environmental stresses on their plants. Please, as a published expert, and as a future medical doctor, do not let a lack of research, or an unqualified judgement like that quoted above, turn good reporting into dangerous, normative spin. And otherwise, thank you for your book. It was a wonderful read.
  Sincerely,
  Christopher Keefe
• 
  India M. Clamp

  This was published in 1997 and there is a blip between chapters and musical transitions. Everything out there is influencing everything else. Dancing and consuming with my eyes/ears Moalem’s Survival of the Sickest: A Medical Maverick Discovers Why We Need Disease was not as fluid yet intrigued me as how the human species adapts to the environment.
  
  A common disease does have an etiologic relationship to the cold, and such is Diabetes he states. Erudition via the way streptococcus has molecular mimicry and are invaders to the body. Voles are a paradigm as to the predictive and adaptive response of babies born into good environments or volatile ones---in-vitro maternal response.
  
  “...in 1397 the plague begins it march across Europe. People who have the hemochromatosis mutation are especially resistant to infection because of their iron starved macrophages…though it will kill them decades later.”
  ---Sharon Moalem, MD, PhD
  
  According to Moalem, hemochromatosis protected people from the plague. Our relationship to disease is more complex than previously realized. Cadence of this book is not such that I accustomed to as---perhaps being weaned on Gawande and Marsh imparts a Zeiss-like lens and a lofty end point or outcome only genius can achieve.
  
  Writing is not scientifically slanted and more appropriate for a common audience. In brief this implies that jargon is a rare animal and not found within. Presentation is one that delights the common reader with monosyllabic treasures. If a gumbo pot from worms to diseases and jumping genes sounds engaging, then this is a read for you.
  
• 
  Muhammed Hebala

  This is a book which is simply incredible and super entertaining .
  
  It amazes me that human beings can live through such huge changes
  
  It talked about how specific common diseases and conditions (like diabetes and high cholesterol) actually may have been naturally selected because they provided an adaptive advantage in a particular environment.
  Hemochromatosis may have helped Europeans to survive the black Death ,and
  Diabetes may have been there evolutionary solution to avoid freezing in
  the ice age, And Favism was our weapon against Malaria.
  
  I enjoyed reading about diseases, genetics, immunity, Epigenetics and history.
  
  This is a fascinating read and a wonderfully-written book .
  
  Very enlightening!
  
  ==========================
  
  Attention undoubtedly will be centered on the genome, with
  greater appreciation of its significance as a highly sensitive
  organ of the cell that monitors genomic activities and corrects
  common errors, senses unusual and unexpected events, and
  responds to them, often by restructuring the genome.
  _________________________
  
  Where there is folklore smoke, there is medical fire.
• 
  Sue

  It's science -- made simple! I got to indulge my inner geek without having to overexert my brain cells. (Well, okay, I did have to read a couple of pages over again to get it, but hey, I was really, really tired that night.) Seriously, I was fascinated by the subject matter -- the interplay of genetics and disease -- and the writing style was wonderfully accessible to the lay reader. If I had read this book in high school (which would have been impossible, since these discoveries hadn't been made yet), I would have a different career today. Yes, I found it THAT interesting.
  
  In a nutshell, the disease that runs up your medical bills today may be the very disease that saved your ancestors long enough to reproduce, and consequently, contribute to your existence. For example, because I know my genetics (I told you I have an inner geek), I know that I am a carrier for a disease that, over time, causes too much iron to accumulate in major body organs. (Don't worry about me, I'm only a carrier -- I'm fine.) What I didn't know is this: the fact that I have this gene means my ancestors -- at least some of them -- must have survived the Black Death that swept across Europe in the Middle Ages, because having this gene makes one more resistant to the bubonic bad guys. (So if the plague makes a reappearance, I'm good!)
  
  If you found that last tidbit interesting, then you will like this book. And if you want to feel hopeful for your grandchildren's future, reflect on this: the day is coming when the drugs you are given for the things that ail you will be individually created just for you and your genotype, increasing the odds that they will be swift and effective. And that's just downright amazing!
  
  
  
• 
  Natasha

  The interconnectedness between disease and certain populations of individuals is extremely interesting and the writing in this book is very entertaining. However, I was bothered by the author's arrogance. It was almost distracting while reading -- the subtitle says it all..."A Medical Maverick Discovers...". "Medical Maverick" is a bold statement when really, the author did a bunch of research and none of his own experiments (or if he did, that wasn't clear from reading the book). And "discovered" implies he came across something no one else knew, when in reality, he took a bunch of concepts that other people figured out and combined those ideas into an entertaining and well-written book.
  
  If you have even a basic understanding of biology, you'll get along with this book fine. If you can ignore other people's boasting, you'll get along with it even better. While I do happen to be sensitive to the author's attitude, I do recommend reading this book if you have even a passing interest in why we get sick.
• 
  Phair

  This was the most interesting book I've read in a long time. I liked the breezy style- kind of 'popular science' approach. Covered a wide variety of diseases & conditions and the genetic & environmental reasons they have remained in the human gene pool. Background on how much of the human make-up is really not human at all but largely viruses in a symbiotic relationship was creepy but interesting. Very cool book.
  Read again in '08 for f2f discussion group.
• 
  Chris

  This book is one of the best books I've ever read. I learned so much and have recommended it to so many people (and have given it as gifts). I learned things I would have never known...so many pieces came together in this book. I would suggest it to anyone who needs a break from their "novel" reading. Switch it up and read this book. You'll be glad you did!
• 
  Randy

  I suppose I judged this book by it's cover, making it a little disappointing when I read it. The author also goes off on some random tangents that I found distracting. That being said, there were some interesting parts -- particularly the discussion of how many genetic diseases are with us because they offered a survival benefit to our ancestors.
• 
  Charlene

  This book was EXCELLENT!
  
  Despite being written in 2007, this book is as up to date as any book about evolution. In fact, it's even better than his 2014 book Inheritance. If you are tired of reading books that work very hard to preserve the image of the selfish gene and are looking for a book that celebrates the newer information researchers have gained since the 1970s, I highly recommend reading this. Geneticist Sharon Moalem examines the role that jumping genes, parasites and viruses, and epigenetic modification play in evolution.
  
  Currently there is a battle raging in academia about whether or not to update the "Modern Synthesis of Evolution," put forward in 1942 by Julian Huxley and supported by Dawkins' work in the 1970s and beyond. Dawkins and his crowd have worked hard to attack anyone who works to update this synthesis with the myriad data that have poured in since his time in the spotlight, which is a shame because the work on this front is mindblowingly good! The field of evolution research needed this book. Helping to get this information to the masses is extremely important if there is any hope for a paradigm shift to a more accurate, updated, and complete understanding of how evolution works. This book will go a long way to helping that shift occur.
  
  Unfortunately, this book makes no mention of one of the researchers who fought the hardest to bring awareness of epigenetic modification to the public. Her name is Eva Jablonka, and Moalem should have mentioned her, but even with that oversight, this book was truly great! Moalem covered McClintock's jumping genes in wonderful detail (better than almost anything I have read to date). These little genes provide a lot of diversity and are the descendants of amazingly clever viruses. He also covered work by Luis P. Villarreal that is extremely current. Villarreal's ideas took some time to catch on. He proposes that viruses work to add diversity to DNA. If DNA were slowly mutated over time, we would not see the change we do. Villarreal's work shows how viruses act like software that add novel instructions to the DNA's more rigid and fixed code. Since this book was written in 2007, you might want to watch Villarreal's more recent talk. Here is the link:
  
  
  https://www.youtube.com/watch?v=amWRu...
  
  Moalem also looked at hypermutations in e. Coli. In many experiments (still controversial today), researchers have found that jumping genes as well as regular genes seem to respond to environmental factors and can order up a faster mutation rate or increased need for genes to jump and fix a problem. Very exciting to think about! He also covered various epigenetic modifications of genes.
  
  Each subject is written about in an easy to understand and extremely entertaining manner. I can't think of a better book to introduce people to what will undoubtedly be the new modern synthesis of evolution.
  
  
• 
  Doa'a Ali

  دراسة الأمراض البشرية كظواهر ثابتة (اعراض معينة تنتمي لمرض معين له سبب وبالتالي دواء) هو اكثر اسلوب سيسجل فشله مع كل حالة طبية جديدة ... لاننا نتنازل عن اهم الحقائق التي توصلنا اليها، وهي ان الثابت الوحيد في هذا العالم هو التغيير ..
  كل شيء يتغير، اجسادنا، مسببات الامراض، تأثير الادوية، غذائنا، هوائنا حتى!
  فنحن لا نعيش بغرفة معزولة بها نفس المدخلات والمخرجات، خاصة اننا نمد ايدينا في كل مرة لاصلاح المشاكل والاعطاب وحتى تأخير الموت ..
  
  يبحث هذا الكتاب في سؤال (لماذا نمرض)؟ لماذا نورّث الامراض لماذا لم يستثني التطور اولئك الذين يتعبون ويظهرون الاما شديدة
  عبر البحث العديد من الامراض، منها السكري وارتفاع الكوليسترول والحساسية من الفول وغيرها، يحاول الكاتب الاجابة عن تفرعات سؤال سبب الامراض ،، او بالاحرى الاسباب الوجيهة للامراض .. كما يبحث في علاقة الانسان المعقدة مع باقي الكائنات الممرضة كالنباتات السمية والميكروبات الضارة ... كما يبحث في المسببات الداخلية في جسم الانسان ..
  
  رحلة ممتعة جدا تعطي اطارا عاما قابل للتعديل لفهم تعقيد المرض والشفاء ..
  
  
  #البقاء_للأشد_مرضاً
• 
  James

  The thesis sounds interesting, but the author doesn't provide very many examples, and for those he does, the evidence is speculative at best.
  Do people have diabetes today because it "may" have helped during the ice age?
  Prove it.
  
  While he tries to explain the past, he offers no ideas as to how things may change now that the ice age is over and plague is rare.
  
  He cites his sources, but if you check them out, many turn out to be ordinary newspapers like US Today.
  These are not valid sources of scientific discovery/information.
  He reminds me of Susan Faludy in that style of "research".
  
  The author has a smart-alecky style of writing at times that makes me think he's writing for a 12 year old audience.
  
  There are better books on evolution and medicine.
• 
  Fishface

  BEST. BOOK. EVER. One fascinating page after another crammed with explanations for all kinds of stuff that goes on in a person's body. He started right out by answering a question I've wondered about for years, and got bonus points for telling me my own wild guess was correct. He got to the childbirth part and I thought, oh, great, here's where the whole book goes splat -- BUT HE HAS NOT ONLY READ ELAINE MORGAN, HE GETS THAT SHE IS RIGHT! If only this book had been twice as long!
• 
  Horace Derwent

  shit
  
  maybe I'm a yellow Neanderthal that'd derived from a water ape
• 
  Abby Stathis

  This was summer reading for AP Bio. At first, I was infuriated. I mean, here I was trying to enjoy my summer, and then all of the sudden I had to read a full on nonfiction book for a course I had already taken a year of?
  
  But then I had the idea to listen to it as an audiobook, and damn, it was absolutely fascinating. It made my 40 minute drives to practice so much more interesting. What’s more? It’s written for an audience without a degree in a scientific field. And let me tell you this: it’s written really, really well.
  
  It’s easy to process yet deals with extraordinarily complex concepts. The basic theme is that evolution happens for a reason and has an extremely far-reaching impact.
  
  I highly recommend this, especially in audiobook format!
• 
  Iva Ts

  Interesting book. I loved how accessible the writing was, the flow of the narration was very good and devided in nice chapters with particular focus. Some observations are very generic, other include curious examples of cases. And while it was informative, i loved that it highlighted how human kind is still at the very beginning of understanding how things work. As customer or side characters we might not like to hear that, but it is eeality and i loved how the text approached this.
• 
  Rossdavidh

  Subtitle: A Medical Maverick Discovers Why We Need Disease. I've noticed that the word "maverick" now sounds phony to me. You can make your own guess as to why. Anyway, Dr. Moalem is here to explain why disease (and our genetic predisposition to it) works differently than we think. Specifically, Moalem seems to be fascinated with how disease has left metaphorical scar tissue on our DNA.
  
  The most famous example of this is sickle-cell anemia. A little basic math indicates that it's a genetic condition that should have died out long ago. Two copies of the gene, and you're going to die before you can reach adulthood and pass on your genes. So, two parents who have one copy each will see about 25% of their children die from sickle-cell anemia. It shouldn't take very many generations of this before people without the gene should have been so much more successful in reproducing that they swamp the gene pool. The answer to this puzzle is that people with one copy of the gene are resistant to malaria. In some parts of Africa, malaria is so devastating that it's worth losing 25% of your kids if 50% of them get to be malaria resistant. This assumes, of course, that malaria has been around a long time, and that it is very, very lethal. Both of these are, sadly, quite true.
  
  This is a story we've read about in many places. Moalem, however, takes the concept and runs with is, seeing how far it can be taken. How many odd genetic conditions, currently negative, can be explained as a reaction to something else? Odd conditions from hemachromotosis (accumulating too much iron in the system, but not in white blood cells) can help resistance to the Black Plague, Our genetic predisposition to retain a high cholesterol level can be explained by how much sun there was in the area our ancestors lived in. And so forth.
  
  Is it convincing?
  
  Well, some of it is. Sickle cell anemia is unlikely to be the only condition explained by a past selection pressure, like a disease (especially one as widespread and lethal as bubonic plague). It's worthwhile to have someone push this theory as far as it can go, to see what else it can explain.
  
  Sometimes, however, I have to wonder how likely it is that all of these scenarios are true. How would you test them? For example, if the horrors of the conditions on board slave traders caused the descendants of those who survived to be especially susceptible to high sodium levels. It's true that many died on board slave ships, so there was the possibility of some genetic difference between those survivors and the average person from the West African populations they had been taken from. I'm not sure that retaining a high salt level is the most likely genetic trait that would increase the survival rate.
  
  What is needed, is some (ethical) way to test these theories. There's a genetic condition, there's a possible circumstance in which it might have been advantageous. How do we test if the supposed advantage is big enough to compensate for the problems? Moalem doesn't always give a lot of evidence there.
  
  More valuable (to a reader like me, if not to society generally) is the basic mindset that looks at each genetic problem and says, "what were the circumstances where this was a good thing?". If it's not so rare as to be explained by simple mutation (i.e. perhaps the person's parents didn't have this gene, it just came about by mutation in this generation), then there is some reason why it didn't die out. The human mind has a tendency to divide things into Good and Bad, and asking when and where the Bad would turn out to be Good is something that takes some practice. Moalem gives us plenty of it.
• 
  Stephen

  Ask the man on the street about evolution, and assuming he doesn’t connect it to Pokemon, he’ll probably identify it as something that happened long ago. But creation is never finished, either underground where tectonic plates grind against one another, producing mountains, or above where endless forms most beautiful prowling around continue to change. We know this well from medicine, because the attempt to conquer a given disease is often frustrated by the sheer pace at which a given bacteria population can. But what if some illnesses continue to be pervasive because it’s beneficial to us? Such is the argument advanced by Sharon Moalem in this, one of the most interesting biology books I’ve read in a while.
  
  How can being susceptible to a disease help us? Diseases are often debilitating, sometimes confining the affected to bed – not exactly a place to take one’s stand in the eternal struggle for existence. But suppose a trait that warped cells ever so slightly – a bad thing, on the face of it — had the effect of preventing an invasive parasite from being able to use those cells, damning it to a death as soon as it had gotten a look around your circulatory system? So it is that sickle cell anemia, which only occurs when two people with those warped cells have a baby, persists in Africa and other places where malaria is common. More people survive malarial attacks than die from it because they’re in possession of those slightly warped cells. (Sickle-cell anemia results when two people with the affected cells have a child, and their child’s cells are so altered they slow the flow of blood.) Another sickness, in which cells horde iron to the point of poisoning their own bodies, is a similar adaptation against malarial infections….but unlike with sickle-cell anemia, those with hemochromatosis can find relief from their internal oxidation by donating blood. These genes persist because, given the odds, they’re more likely to help persons carrying them than to hurt them.
  
  After exploring other cases like this, including a speculative argument that the European propensity for diabetes is an adaptation to the northern climes during the last glacial period, Moahem shifts an even more fascinating topic: methlyation, or the processed by which traits expressed by your genes can be turned off and on, or otherwise modulated, because of factors in the environment, both prenatal and postnatal. We encounter mammals who give birth to different colored offspring depending on how much light the mother is exposed to — allowing her to bear white babies in winter, when snow is on the ground, and brown ones during the summer. Human mothers’ environments also change them: when on a starvation diet, or when eating mostly nutrient-poor junk food, they give birth to small babies that grow up with horders’ metabolisms. Why this has happened is fairly easy to guess: children born in times of famine need to hold on to every scrap of spare glucose they can. Towards the end, Moalem shifts a little off topic to examine other environmental effects on our genes and their expressions, sharing the argument of some that human beings have been partially shaped by a maritime environment, driving our hairlessness and bipidalism.
  
  Survival of the Sickest has been on my to-read list for many years now, and I’m extremely glad to have finally sat down and taken it on. It’s in the same vein as Randolph Nesse’s Good Reasons for Bad Feelings and Why We Get Sick, the former of which I plan on reading before too long.
• 
  Marcia

  I really enjoyed this book. So much so that I looked up other books by the same author. It's a very interesting topic, and written in a way that us laypeople can understand. If you have a background in biology of any kind you might find this elementary. As a person who narrowly failed 10th grade Biology, this was not an issue for me. If I had read this in 10th grade it might have made me more interested in the subject.
• 
  Clare

  I had to read this for my summer work for AP bio. I really enjoyed it, as I love learning about evolution. This book shows amazing connections between diseases and our natural ecosystems, and analyzes relationships with microorganisms and other living things. I learned a lot and was compelled the whole time.
• 
  Heidi Hollister

  With our current pandemic lives, this book feels even more important. I highly recommend it. Whether you live with chronic illness or not.
• 
  Laurent

  The primary purpose of Moalem's work is to explore our physiology and its relationship to the world around us; its overarching message? Never to stop questioning.
  
  This is a noble message, and one that we must all take to heart in everything that we do. Sadly, it is also something that the reader must keep in mind, almost at every turn, while reading the book itself. Moalem's lack of transparency regarding the factual emptiness of his ambitious conjectures is staggering. Only in the last chapter does it become clear that the book relies on a series of mere guesses and 'what ifs,' none of which can, as of yet, be backed with factual information. Furthermore, the book itself seems to follow no identifiable path: it flits from one topic to another, disappointingly failing to explain why we 'need' disease, as it advertises on its cover.
  
  As a post-script I would add that, in fact, several of the theories advanced in this book have been refuted by the scientific community, most significantly his speculation that Type 1 Diabetes has developed in humans as a result of the rapid onset of the last known ice age. In short, a trivially interesting read for a layman, but by no means satisfying, enlightening or thoroughly composed.
• 
  Elyse

  One of the most interesting things I learned in this book is that, like a toaster, humans have planned obsolescence. Toaster manufacturers want to sell new toasters and Mother Nature wants new people at a fast clip to replace old people full of disease who can no longer reproduce. I always thought people just got worn out and died. Not so - our DNA is programmed to make us die. This book is full of "fun" facts like this. The author is enthusiastic about life and his interests. The only slight negative is that he toots his own horn a bit too much for me. He has interesting things to say and gives credit to those who first introduced the ideas he describes.
• 
  Dominic Carlin

  Look, you don't need to read much of this to say it's crap. The writing is crap and the end of every section/chapter seems to sign off with a pithy comment. The author has 'Dr' in front of their name on the front cover, which should have raised alarm bells long ago. And the science/medicine is speculative at best. This could have been a half-decent New Scientist article, it didn't need much more than that.
  
  -Dr Baby Hamster PhD