Survival of the Sickest: The Surprising Connections Between Disease and Longevity

by Sharon Moalem, Jonathan Prince (Contributor)

Read it. You're already living it. Was diabetes evolution's response to the last Ice Age? Did a deadly genetic disease help our ancestors survive the bubonic plagues of Europe? Will a visit to the tanning salon help lower your cholesterol? Why do we age? Why are some people immune to HIV? Can your genes be turned on -- or off? Joining the ranks of modern myth busters, Dr. Sharon Moalem turns our current understanding of illness on its head and challenges us to fundamentally change the way we think about our bodies, our health, and our relationship to just about every other living thing on earth, from plants and animals to insects and bacteria. Through a fresh and engaging examination of our evolutionary history, Dr. Moalem reveals how many of the conditions that are diseases today actually gave our ancestors a leg up in the survival sweepstakes. When the option is a long life with a disease or a short one without it, evolution opts for disease almost every time. Everything from the climate our ancestors lived in to the crops they planted and ate to their beverage of choice can be seen in our genetic inheritance. But Survival of the Sickest doesn't stop there. It goes on to demonstrate just how little modern medicine really understands about human health, and offers a new way of thinking that can help all of us live longer, healthier lives. Survival of the Sickest is filled with fascinating insights and cutting-edge research, presented in a way that is both accessible and utterly absorbing. This is a book about the interconnectedness of all life on earth -- and, especially, what that means for us.' to 'Read it. You're already living it. Was diabetes evolution's response to the last Ice Age? Did a deadly genetic disease help our ancestors survive the bubonic plagues of Europe? Will a visit to the tanning salon help lower your cholesterol? Why do we age? Why are some people immune to HIV? Can your genes be turned on -- or off? Joining the ranks of modern myth busters, Dr. Sharon Moalem turns our current understanding of illness on its head and challenges us to fundamentally change the way we think about our bodies, our health, and our relationship to just about every other living thing on earth, from plants and animals to insects and bacteria. Through a fresh and engaging examination of our evolutionary history, Dr. Moalem reveals how many of the conditions that are diseases today actually gave our ancestors a leg up in the survival sweepstakes. When the option is a long life with a disease or a short one without it, evolution opts for disease almost every time. Everything from the climate our ancestors lived in to the crops they planted and ate to their beverage of choice can be seen in our genetic inheritance. But Survival of the Sickest doesn't stop there. It goes on to demonstrate just how little modern medicine really understands about human health, and offers a new way of thinking that can help all of us live longer, healthier lives. Survival of the Sickest is filled with fascinating insights and cutting-edge research, presented in a way that is both accessible and utterly absorbing. This is a book about the interconnectedness of all life on earth -- and, especially, what that means for us.

Genres: Science, Nonfiction, Health, Medicine, Medical, Biology, Evolution

370 pages, Kindle Edition

First published January 1, 2007

About the author

Sharon Moalem, MD, PhD, is an award-winning physician-scientist and geneticist. He is the author of the New York Times bestseller Survival of the Sickest and Inheritance, an Amazon Best Science Book of the Year, among other books. His work brings together evolution, genetics, and medicine to revolutionize how we understand and treat disease, and his clinical research led to the discovery of two new rare genetic conditions, and to his discovery of a first-in-class antibiotic which targets ‘superbug’ infections. His books have been translated into more than 35 languages.

Reviews

[Katherine · Rating 1 out of 5]

This is a prime example of the problems with science books written for a lay audience. The author regularly presents hypotheses/hunches than he believes as if they're well-supported by science
I picked this book up because it spent time on my field of study, infectious disease. The first chapter was okay, but then it just went downhill from there. The type 1 diabetes chapter that posits that it aids in survival in a cold climate is laughably implausible. Moalem states that "some scientists" believe that type 1 diabetes is autoimmune. One would be hard pressed to find a biologist who does not think that T1D is autoimmune, the evidence is just that strong. T1D occurs in people with certain alleles of the HLA gene. These genes are involved in the immune response; immune-related genes tend to become more diverse quickly, so it's unlikely that these HLA haplotypes are present in modern humans because they improved survival in the cold 12,000 years ago. Also, there is the point that untreated, type 1 diabetes is fatal very quickly. Before Insulin was developed, the only way to keep these patients alive was through an extreme starvation diet.
There are also a lot of sloppy mistakes such as the mix up of virus and bacterium (possibly an editing error?) and the use of the term gene when "allele" is correct -- it's not that hard to explain the difference.
My other main complaint is the reliance on speculative sources rather than sources where someone has done the actual experiments and gotten actual results one way or the other.

[Travis · Rating 3 out of 5]

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.

[حبيبة · Rating 2 out of 5]

كتاب مستفز!

النصف الأول من الكتاب بيتكلم عن مجموعة من الأمراض (الصباغ الدموي Hemochromatosis - البول السكري Diabetes mellitus - حساسية الفول Favism) وغيرها..
بيتناول الأمراض دي من منظور مختلف، وهو إن بالنسبة لبعض الناس كانت الأمراض منحة مش محنة، وساعدتهم إنهم ينجوا من خطر أكبر كان بيهدد البشر يومًا ما، زي الطاعون والعصر الجليدي والملاريا وغيرهم..

الكتاب في أغلبه معتمد على "نظريات" مش حقائق وليها إثباتات، ف أنا شخصيًا مش هثق في المعلومات المذكورة ثقة كاملة، كمان مفيش قائمة مصادر ولا مراجع في الآخر! طب اللي عايز يتأكد أو حتى يقرأ أكتر عن أي موضوع اتذكر في الكتاب يعمل ايه؟ مش عارفة.

كمان الكتاب بيستفيض في شرح أجزاء ملهاش علاقة أوي باللي بنتكلم عنه، يعني يفرد خمس ست صفحات عن الحيوانات مثلًا أو الچيولوچيا أو المناخ، عشان يطلع منهم بفكرة متعلقة بالموضوع الأساسي، طب ما كنت تلخص الفكرة دي في نص صفحة ولا حاجة! كنت شايفاه تشتيت ورغي ملوش لازمة بصراحة.

النصف الثاني من الكتاب مش بيتكلم عن أمراض محددة، بيتكلم بشكل عام عن علاقة الإنسان بالبكتيريا والڤيروسات، وعلم الوراثة وما فوق الوراثة Epigenetics، وآلية الشيخوخة.

الفصول دي بالذات معتمدة كليًا على نظرية التطور والانتخاب الطبيعي، فطبعًا أي حد عنده أسئلة وشكوك في نظرية التطور مش هيصدق الكلام بسهولة، الكتاب بيتعامل إن مبدأ التطور Evolution والانتخاب الطبيعي Natural selection دي مبادئ أساسية مُثبتة علميًا، وباني كل كلامه ونظرياته عليها، فأكيد دا كان عقبة إني أصدق المكتوب، لأني محتاجة أقرأ عن التطور الأول.

كمان نقطة كانت بتقفلني من القراءة: أسلوب الكتابة صعب فعلًا! معرفش دي مشكلة ترجمة ولا ايه بس الجمل مكانتش سلسة كدا وكنت ساعات بقرأ الفقرة مرتين عشان أفهم، مش عشان صعوبة المحتوى، تركيب الجمل نفسه كان فيه حاجة غلط. كمان الشرح نفسه مش مبسط بالقدر الكافي! يعني بعض موضوعات الكتاب درستها في الكلية بالفعل، كتاب الكلية الأكاديمي الممل كان أسهل من أسلوب الكتاب دا أوقات!

لزيادة الاستفزاز.. خاتمة الكتاب بقى، الكاتب بيقولك قد ايه لازم نكون ممتنين لنعمة الوجود والصحة، عشان الكون بتاعنا يتجه نحو "الفوضى" ، وكل "قوى" الكون بتوجهنا نحو الفوضى.. سبحان الله والله! ازاي مع كل العلم والتجارب والبحث والنظريات، حد يكون شايف إن الكون عبارة عن "فوضى" في نهاية المطاف!

قال الله تعالى ﴿إنا كل شيء خلقناه بقَدَر﴾.

زي ما قلت، مش هعتمد الكتاب دا كمصدر علمي موثوق، وهعتبره مجرد كتاب للتسلية مع شوية معلومات مفيدة، لحد ما ربنا يفتح عليا ويعطيني الوقت والجهد اللي يسمحوا لي أقرأ في المجالات دي بتوسع أكبر ومن مصادرها الصحيحة الموثوقة.

يا رب علمّنا.

[ولاء شكري · Rating 5 out of 5]

"البقاء للأقوى أو البقاء للأصلح"
جملة تلاحقنا في كل مكان كعقيدة ثابتة للتطور!

ولكن هذا الكتاب يقدم نظرية مدهشة وفريدة لمفهوم المرض، لا سيما المرض الذي نتوارثه في جيناتنا، فيطرح فكرة أن بعض الأمراض قد تحمى الإنسان من أمراض أخري أشد فتكاً، وتساعده على البقاء في الوقت الذى قد يهلك فيه الأصحاء.

فمثلاً، مرض الصباغ الدموي (ترسب الحديد) ومرض فقر الدم ساهما في توفير الحماية من الطاعون بحرمان البكتيريا من الحديد الذي تحتاجه للبقاء، ومرض السكري قد ساعد الأوروبيين القدامى على النجاة من البرد المفاجئ في الدرياس الأصغر، ومن لديهم حساسيه من الفول لديهم مقاومة طبيعية أفضل للملاريا.

أذن البقاء قد يكون للأشد مرضاً!

فكل ما هو على قيد الحياة يريد شيئين: البقاء والتكاثر، وبالطبع نحن كذلك أيضا الفرق - ميزتنا الكبيرة - هي أمر واحد فقط ..
نحن نعرف ذلك.
لذا من خلال فهم كيفية تطور الكائنات الحية المسببة للأمراض المعدية- وكيف يؤثر تطورها على تطورنا - نكتسب رؤية جديدة حول كيفية حدوث الأمراض وتأثيرها علينا وكيف يمكن السيطرة عليها لصالحنا.

》كتاب علمي، رائع، طرح الموضوع بسلاسة شديدة.

[Chris Keefe · Rating 4 out of 5]

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 · Rating 2 out of 5]

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. Some facts within may require verification.

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 · Rating 5 out of 5]

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.

[using · Rating 4 out of 5]

Marketing looked like a complete ripoff of Freakonomics. Style reads like Freakonomics with a personal health/medicine spin.

Too boldly mixes well accepted medical observations: Sickle Cell Anemia is related to genes that provide resistance to Malaria. Get one you're good, get two you're screwed.

With absolutely left field speculation: African-Americans have high incidents of hypertension and heart disease due to a artificial selectional pressure exerted on them by their ancestors' passage across the Atlantic during the slave trade. Being given very small rations of water created a selectional pressure for those that could retain salt, thereby retaining water and surviving. Seems to make logical sense but there is nothing to back this up.

[Sue · Rating 4 out of 5]

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 · Rating 3 out of 5]

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.

[Charlene · Rating 5 out of 5]

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 · Rating 5 out of 5]

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

[Phair · Rating 5 out of 5]

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 · Rating 5 out of 5]

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 · Rating 2 out of 5]

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.

[Maci · Rating 4 out of 5]

Survival of the Sickest was informative constantly throughout the entire book. The flow of the book was really amazing, Dr. Moalem began the book with diseases such as Iron Deficiency, High Cholesterol, and Diabetes and he ends the book with life and death. He used his knowledge to create a book about genes and the mutations that occur within them while also painting the story of life. He explains why people are beginning to be overweight more and more. I have questions about the process of accumulating all the information within the book, he mentioned more experiments than I could even think to count. I also question specific processes, I would have liked to go more in depth on the patterns and processes that occur in the body. I think this book could have easily been 400 pages and still not answer all the questions because the development of antibodies alone could be an entire book. On the matter of recommending this book to others it would greatly depend on the person, someone who likes living a simple life. I would not recommend this book as it makes you think a lot about life and the processes in it. However someone who has a hunger for knowledge and is constantly questioning life itself I would recommend this book to. I think personally that this book is a great foundation for anyone who has questions about diseases, genes, and life itself. Reading it was a joy and I can truthfully say that the knowledge I have that results from this book will greatly benefit me in the future.

[Jordan Judd · Rating 3 out of 5]

3.5 💚 I had to read this book 7 years ago as summer reading for my AP bio class junior year. back then I really did not understand much. now, almost a year into being a provider, I have a much better appreciation for everything. crazy to think how far I have come!

this book offers insight into diseases, such as hemochromatosis, diabetes, G6PD, etc, and why they were evolutionarily developed! very interesting read and gives great perspective into the benefits of diseases that we now consider troublesome. so much still to discover about the genome! our bodies continue to evolve to do amazing things for us- and we rarely even know it!

[Marjorie · Rating 4 out of 5]

3.5

[Nader Mohamed · Rating 3 out of 5]

كانت قراءة ممتعة وثريّة وتفتح أبوابًا للتفكير ورؤية للأمراض بمنظور مختلف.. لكن عند الكاتب مرونة وتساهل كبير جدًا في قبول نظريات وافتراضات كثيرة غير ثابتة علميًا ويبني عليها نتائج وخلاصات نهائية تخدم فكرته التي بدورها لا يمكن الحكم عليها أنها نظرية علمية (بالمعنى الكلاسيكي الشائع عن العلم أو الـ science) والأنكى من ذلك أنه يبدأ وينطلق من نظرية التطور الداروينية وإليها ينتهي، ويتعامل معها على أنها مسلّمة مطلقة يجب أن تفسَر كل الأحداث البيولوجية والبيوكميائية على أساسها، وهي الباراديم المهيمن على الكتاب من المقدمة إلى الخاتمة، فأكثر الوظائق والآليات الحيوية وسلوكيات الخلية الحية أو الكائن الحي الموصوفة في الكتاب لا تكاد تجدد لها مفسرًا إلا أن الضغط التطوري يقف وراء ذلك كله، الأمر الذي يقضي على الموضوعية العلمية للكتاب، ويجعله أقرب إلى نظرية فلسفية منه إلى الحقل العلمي.

الشيء الغريب المستنكر أن المؤلف يصف -في خاتمة كتابه- التطور بالمعجزة (وهي كلمة مبهمة بالنسبة للحقل التجريبي) ويضعه في صراع مع قوى الكون "الفوضوي"!

ورغم ذلك أرى الكتاب يستحق القراءة بشدة ويستحق أكثر المزيد من البحث والتأمل في الفكرة العامة له وإعادة صياغتها بوعي أكبر ونظرة أعمق وأكثر شمولية دون الوقوع في أسر هذَيانات دارون وأبنائه.

[James · Rating 2 out of 5]

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 · Rating 5 out of 5]

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!

[Isabelle L · Rating 5 out of 5]

So yeah this took me almost a month I don’t want to talk about it. But ignoring that this was actually so so good. I feel like I learned a lot and it was really interesting to read. Like I could actually rave about it it was so good. Even if you’re not taking ap bio next year I highly recommend it. I think my favorite parts was the chapter about epigenetics and maybe virulence? I don’t know it was all so good. And my excuse for it taking so long is band camp and also the reading guide because if I was just at home and not doing the reading guide I guarantee it wouldn’t have taken me this long. Anyways absolutely 5 stars best nonfiction book I’ve read.

[Abby Stathis · Rating 5 out of 5]

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 · Rating 3 out of 5]

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.

[carly · Rating 4 out of 5]

read for ap bio summer reading but it honestly wasn't that bad and was pretty interesting at some points

[Neill Bates · Rating 3 out of 5]

3.12 ✴️

[Alyssa Santos · Rating 3 out of 5]

*3.5 stars

[Anagha · Rating 5 out of 5]

26th book to celebrate entering my 26th year of life! Really well-researched and thoughtful book that answers the question of "Why do we have disease? with the answer "Because it helps our survival on the population level." By thinking about diseases like hemochromatosis and type 1 diabetes through the lens of adaptation to ancient environments, Moalem points out that we are part of a vast (and still unfolding) evolutionary story. Absolutely brilliant book!

[Rossdavidh · Rating 3 out of 5]

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 · Rating 4 out of 5]

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.