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

Dan Ariely on Survival of the Sickest
MIT professor Dan Ariely has become one of the leaders in the growing field of behavioral economics, and his bestselling book debut,

_ I have always been puzzled by the way in which genetic diseases have managed to survive throughout the ages. How could it be that these diseases were able to withstand the evolutionary process, where only the most fit survive, and continue to be transferred from one generation to the next? Survival of the Sickest provides a thought provoking yet entertaining explanation to this puzzle. _

In this insightful book Dr. Sharon Moalem demonstrates how conditions that are considered unhealthy (such as hemochromatosis, diabetes, and high cholesterol), or even deadly in extreme cases, might actually put their carriers at an advantage in combating other life-threatening illnesses. For example, he explains that hemochromatosis, a disease that, if left untreated, will kill you, may have actually been a defense against the deadliest pandemic in history--the bubonic plague during the 14th century. It turns out that this genetic mutation, which continues to be passed down through generations, actually helped spare many lives at one point.

Throughout the book, Dr. Moalem draws many connections between seemingly disparate subjects, such as the accidental invention of ice wine and cold diuresis, in order to illustrate the basic mechanisms of genetics and medicine in charming and intuitive ways. He skillfully interweaves his knowledge of history, genetics, and medicine not only as they relate to specific medical conditions but also in a way that addresses important challenges of modern society and our future evolution.

In the most general terms, Dr. Moalem's description of the human body and its complexity left me in awe of how far we have come in our understanding of biology and medicine, while also being reminded that the road to understanding ourselves is still wide open with much more to learn in the decades, and even centuries, to come. It is a fantastic journey on which he leads us and Dr. Moalem is a kind, knowledgeable, humorous, and helpful guide.

Moalem, a medical student with a Ph.D. in neurogenetics, asks a number of provocative questions, such as why debilitating hereditary diseases persist in humans and why we suffer from the consequences of aging. His approach to these questions is solidly rooted in evolutionary theory, and he capably demonstrates that each disease confers a selective advantage to individuals who carry either one or two alleles for inherited diseases. But very little is new; the principles, if not every particular, that Moalem addresses have been covered in Randolph Nesse and George Williams's Why We Get Sick, among others. Whether he is discussing hemochromatosis (a disorder that causes massive amounts of iron to accumulate in individuals), diabetes or sickle cell anemia, his conclusion is always the same: each condition offers enough positive evolutionary advantages to offset the negative consequences, and this message is repeated over and over. Additionally, Moalem's endless puns and simple jokes wear thin, but his light style makes for easy reading for readers new to this subject. (Feb.)
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