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Why We Get Sick: The New Science of Darwinian Medicine

Article  in  Medical Anthropology Quarterly · January 2008

DOI: 10.1525/maq.1997.11.2.258

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 REVIEWS OF
Why We Get Sick: The New Science of Darwinian Medicine
by George C. Williams, Ph.D. and Randolph M. Nesse,
M.D. Times Books, 1995 ISBN: 0-8129-2224-7
By specialists and ordinary readers.
• "This is the most important book written about issues in biomedicine
in the last fifty years. When the world's leading evolutionary biologist
(Williams) teams up with a thoughtful physician (Nesse), the product is a
gripping exploration of why our bodies respond the way they do to injury
and disease."
—Michael S. Gazzaniga, Ph.D.,
director, Center for Neuroscience,
University of California at Davis
• "Every so often, a book comes along that has power to change the way we
live and die.
This splendid book is one, and it could well revolutionize the way physi-
cians are taught, the way they practice, and even the way parents watch
over their child with a fever or a cough."
—Professor Robert Ornstein,
author of The Psychology of Consciousness
• " Why We Qet Sick is certain to be recognized as one of the most important
books of the decade, and what's more, it's beautifully written"
—Roger Lewin
Author of Human Evolution, 3rd Edition
• "By bringing the evolutionary vision systematically into one of the last
unconquered provinces, Nesse and Williams have devised not only means
for the improvement of medicine but fundamental new insights into the
human condition."
—Edward 0. Wilson. Harvard University
• "Buy two copies and give one to your doctor."
—Richard Dawkins, author of The Selfish Gene
• "Darwinian medicine . . . holds that there are evolutionary explanations
for human disease and physical frailties, just as for everything else in
biology, and that these insights can inspire better treatments. In Why We
Get Sick ... two proponents of Darwinian medicine lay out the ambitious
reach of the adventurous new science"
— The New York Times Magazine
• "Would you accept that eating certain kinds of red meat could help ward
off heart attacks? That taking aspirin when you are sick could make
things worse? That mothers should sleep right next to infants to prevent
sudden infant death? You might after hearing how your prehistoric ances
tors lived, according to a small but growing tribe of 'Darwinian medicine'
thinkers. They argue that for too long physicians have ignored the forces
that shaped us over evolutionary eons. . . . Such ideas are . . . contro
versial, but that's the point."
— Wall Street Joumal
• "Why We Get Sick offers both a provocative challenge to medicine and a
thoughtful discussion of how evolutionary theory applies to people."
—Business Week
• From Publishers Weekly
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.
• From Library Journal
Offering new insights on the failure of evolution to eradicate disease, psy-
chiatrist 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.
• From Booklist
Although they realize that evolution selects not for health but for repro-
ductive 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 be-
cause 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, Dar-
winians 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
• Why We Get Sick: The New Science of Darwinian Medicine
Review by Niraj Mistry
The book, Why We Get Sick: The New Science of Darwinian Medicine is
the result of the collaboration of two great evolutionists: Randolph M. Nesse
and George C. Williams. Nesse is a practicing physician and associate
professor of psychiatry at the University of Michigan Medical School and
Williams is a professor emeritus of ecology and evolutionary biology at the
State University of New York at Stony Brook. Together they have put forth
a very compelling case for the usefulness of evolutionary thought in modern
medicine. This book is extremely readable and stimulating and is bound to
make one look at illness in new light.
The introductory chapters are written in a very clear and non technical
way, offering a primer on the basic principles of evolutionary biology, an
area that has been sorely neglected by the medical profession. The authors
then go on to their main premise: that diseases must be understood from
the perspective of evolutionary biology. This new view of thinking
emphasizes not only how diseases occur, but also why they continue to
exist and have not been eradicated by natural selection. This theme is
explored by identifying and explaining how an adaptation or trait serves
its purpose, and how both genes and the environment influence this out-
come. Throughout the book it is stressed that these explanations can and
should be tested.
Many hypotheses are provided, some supported with empirical evidence,
of the major causes of diseases including: defenses, infection, novel envi-
ronments, genes, design compromises and evolutionary legacies.
After the introduction, the next chapter provides an explanation of the
functional approach to the signs and symptoms of disease. For example,
the authors address how a fever can be beneficial as it raises body
temperature to interfere with the chemistry of some pathogens, thereby
killing them. Nesse and Williams state that in some cases medications
may not be required to reduce fever and may in fact prolong the time of
illness. Thus, it is important to make a distinction between the defensive
mechanisms of our body and those that are not.
Accordingly, the book proceeds to explore the perpetual arms race between
hosts and parasites, including bacteria and viruses.
Microorganisms evolve very quickly, often changing more in a single day
than the entire human race can in a thousand years.
This grossly unfair handicap has left humans in an ever-lasting struggle
with bacteria and viruses despite our highly effective immune system.
In this case, the authors address the improper management of bacterial
infections with penicillin and the reemergence of tuberculosis and other
infectious diseases in more-resistant-to-treatment and deadlier forms that
result from a swift evolution. Every individual needs to come to grips with
evolutionary biology or risk becoming a victim of it.
Nesse and Williams then continue by exploring how some of our health
problems may be the result of evolutionary hangovers from the Environ-
ment of Evolutionary Adaptation (EEA) back in the Stone Age. For
example, dyslexia was not a problem in the past as there were no books
to read.
However, it may have been advantageous because it allowed a quicker,
better understanding of the objects being viewed since dyslexics process
information in different areas of the brain than do non-dyslexics. Further-
more, our predisposition to eat too much fat or drink too much alcohol
may be explained b the scarcity of these consumables in the EEA, when it
made sense to have as much as possible when these were available.
These are examples of illnesses caused by our "novel (modern) environ-
ment," for which our 'Stone Age' bodies are not adapted.
The next chapter examines diseases that are influenced by the modern
environment and genetics, such as myopia. Nesse and Williams show
that while genetically influenced, the modern environment, especially the
reading of books, is the cause of the epidemic of myopia that modern
humans experience.
 However, it is also possible that myopia is an adaptive characteristic under
certain conditions where those who concentrated on things small and
up-close might well identify and process food sources overlooked by
others.
The final few sections are more thought-provoking and depict the mecha-
nisms involved in illness and health in a new light.
First, the authors argue that an allergic reaction, characterized by an
over-active immune system, operates on the principle that an overreaction
to something harmless is better than an underreaction to a real threat. By
analogy, jumping and fleeing at the sight of a rope lying on the ground
may be a little embarrassing since the rope is not a snake, but this little
harmless error is better than being too slow to escape from the danger a
real snake may present itself. Following this topic, the issue of cancer is
addressed and specifically the rationale for cancers of female reproductive
organs. From a historical perspective, these cancers are less common in
women that have a 'Stone Age' life pattern with late menarche, early
menopause and an overall lower number of menstrual periods than average.
Next, the authors postulate that there may also be an evolutionary reason
to welcome morning sickness. Nesse and Williams provide evidence that
nausea and food aversions during pregnancy have evolved to impose dietary
restrictions on the mother so as to correspond with periods of fetal
vulnerability and thereby minimize fetal exposure to food toxins. Finally, a
particularly intriguing chapter examines the possibility of an evolutionary
contribution to psychological disorders such as excessive anxiety or
depression.
Overall, Why We Get Sick offers a novel way of thinking about health and
illness. The authors do not argue that evolution is the main cause of why
we have certain diseases, but they have done a brilliant job in exploring
this side of the argument.
Through a carefully detailed and lively discourse, the authors have ap-
plied evidence and insights from the principles of evolutionary biology to
the dilemmas of modern medicine. Their framework is well organized and
stimulates readers to consider how an evolutionary perspective can shed
light on a multitude of problems. Many physicians are not familiar with
this standpoint and thus Nesse and Williams encourage students and
physicians to study more genetics and evolutionary biology to look for the
evolutionary and not the proximate causes of disease.
As physicians it is essential that one explore an evolutionary approach for
the successful understanding and treatment of disease.
• Review: Why We Get Sick
(Published in the UK as 'Evolution and Healing')
From: Margaret Henderson at CSHL Library
I just finished reading the following book and I wanted to let others know
about it.
 This book is a fascinating look at why our human history and prehistory is
important in any research about disease and health. The authors have
written a highly readable book about the new field of Darwinian medicine -
finding evolutionary explanations for why we get sick. It involves the
study of why certain traits from our past can cause disease today, and
why some traits that are maladaptive today, may have been a help to our
ancestors, the early hunter-gatherers.
There are sections on injury and infection, genetic diseases, cancer, preg-
nancy, aging, and psychiatric problems. Having recently had two children,
I was very interested in the theories about 'morning sickness' and the fight
between the mother and fetus. The authors discuss the theories of several
researchers. For example one theory suggests that 'morning sickness' could
be an adaptation to keep us away from strong tasting foods which are
usually high in toxins during the critical first few months of pregnancy.
There are also evolutionary explanations for why we crave fat, sugar, and
salt.
The authors are very careful to stress that they are not just another medical
fad. They want to work with the medical establishment to provide better
treatment and understanding of illness. It has recently been shown that
running a fever has a function in healing of certain illnesses. With the
help of Darwinian medicine, a doctor would know when to let a fever run
its course and when it is best to bring a fever down with medication.
I recommend this book for any library collection. Doctors in hospitals
and at medical schools should be aware of it. Any public library patron
would enjoy reading it and find it highly informative. And students of
any discipline would find it interesting and I'm sure would get ideas about
how evolution effects all sorts of things in our daily life.
Internet Source: http://www.ghsl.nwu.edu/BLAB/BLA
• Why Evolution Is Important to Our Health, August 02 2005
Both authors are scientists of the highest caliber, and "Why We Get Sick" is
a marvelous, important, and valuable read. The book's purpose is to
include functional evolutionary explanations into ordinary medicine, a
project that is only slowly coming to be. The key to unlocking so many
mysteries behind so many diseases is to look beyond proximate causes
and look instead for functional, often evolutionary, causes of disease and
dysfunction. This requirement demands that we don't stop at signs and
symptoms of disease, but that we understand how the disease disrupts
the function of organisms. Only by a functional understanding of disease,
which requires an evolutionary perspective, can we both prevent and treat
disease more quickly, accurately, and thoroughly.
The classic case is fever. Hopefully, we all know that most fevers are
generally good for us (to a degree), namely that it is the body's own
defense mechanism to raise the body's temperature to help kill pathogens.
 Some fevers, obviously, need to be treated with aspirin, but by doing so,
you may actually prolong the disease. If we understand that fevers play a
vital evolutionary role in helping us ward off pathogens, we'll not want to
reduce a fever unless absolutely necessary (e.g., very high temperatures).
Our body's own immune system is a marvel of evolution at work; and
we need to learn to work with it, not work around it, much less against it.
Certainly we ought not be taking antibiotics for viral infections, yet
patients demand it, and doctors give in. There are health consequences
to this slipshod type of medicine.
If we understand, similarly, that being biped is relatively recent in our
evolutionary history, and we understand how our visceral girdle is designed
for quadrupeds, not bipeds, then the fact that so many of us get back pain
should not come as a surprise. And, the more sedentary and unexercised
this girdle becomes, the more prone to back disorders (e.g., herniated
discs) we become. Part of the evolutionary scheme of things is preventative
as well as curative, so rigorous exercise of our midriff girdle will do much
to prevent back disorders resulting from flabby girdles. By taking the
evolutionary function into account, we are better able to prevent as well
as treat most disorders.
These are just two examples of a plethora of diseases that, when given
their functional aetiology, give a fuller account of what steps are necessary
to keep us healthy and which steps are necessary to treat illnesses. The
authors maintain that we must get to the true, real, and functional cause
of most disorders before we have a real grasp of disease itself, thereby
opening the door to both conventional and evolutionary prevention and
treatment. I can't possibly do justice to the depth and breadth of this
very important work. While I believe it should be in every doctor's library
(like "Darwinian Psychiatry" should be in every psychiatrist's library), it
is also one book most health consumers need to understand. Some parts
are challenging reading, but it's worth it.
I do have several criticisms. First, the book is not the finest in scientific
writing for the layperson. Many doubly compound sentences (and subjects)
would have been better developed with a shorter, simpler sentential writing
style. Second, no footnotes; there are notes at the end of the text, and no
bibliography. Third, the organization and presentation in the first part of
the book could be better, with implications made explicit. These criticisms,
while not major, do affect the overall rating of the book.
• Stimulating, important, clear., March 02 2004
From an evolutionary standpoint, it is reasonable to ask why we are
plagued with disease, both physical and "mental", and why we age. It is
not so hard to understand if the disease is due to viruses or bacteria, which
evolve along with us in an evolutionary arms race. For this reason, some
scientists have postulated that many illnesses ranging from heart disease to
schizophrenia are also due to living organisms, and certainly
 there is increasing evidence for the importance of this viewpoint. Nesse
and Williams provide other answers. Some of these answers - changes in
environment and habits, rare mutations - are straight forward; others are
more subtle and interesting. More than anything, there are inevitably
tradeoffs. The gene which causes sickle cell anemia helps protect against
malaria. In a few instances, an evolutionary perspective provides imme-
diate suggestions for changes in medical practice, in the care of newborns
and in the treatment of fever. More significantly, it has a role to play in
the guidance of future research aimed at specific diseases. The book falls
somewhere between a popular explication, and an original contribution,
the contribution primarily being that it organizes many separate findings,
and sets them out in a more general framework, while posing a host of
possible PhD research questions. Much of the background information
in Why We Get Sick is of great interest, and I only wish there was more
background on the immune system. The writing is competent, and almost
always clear.
• Evolutionary thinking is critical to managing disease, October 05
2003
There is a growing realization that many diseases are related to or caused
by pathogens. Lack of understanding of evolution of microorganisms
makes us ineffective at treating disease.
The evolution of antibiotic resistance is a good case in point. Working
with advanced electromagnetic technologies to eliminate pathogens
quickly demonstrates that evolution of microorganisms can occur quickly
enough to affect treatment during the course of treating a single episode of a
disease in a single patient. There needs to be a new field of the science of
internal ecology of the body that builds understanding of the ecosystems
of the microbiological agents that outnumber our cells.
That said, Nesse and Williams give an easily readable primer on some of
the fundamental evolutionary thinking essential for successful understand-
ing and treatment of disease. It is unfortunate that more physicians
are not deeply familiar with these issues. The improper handling of
disease with current antibiotics makes the organisms that cause them more
deadly. This could easily be minimized by correctly approaching
treatment from a base of understanding of evolutionary biology.
While this book is a good step into the deep waters of internal ecology, its
easy reading makes it somewhat superficial. To start getting the real scoop,
you need to read Ewald's work. A good starting point is Plague Time:
How Stealth Infections Cause Cancer, Heart Disease, and Other Deadly
Ailments.
As one simple example, Plague Time points out that the Borna virus is
usually associated with Bipolar disease. After working with a few indi-
viduals with Bipolar disease, I've found they invariably have the Borna
 virus. This is untreatable by conventional medicine. Using electromag-
netic techniques, the virus can be eliminated or reduced in number. This
results in immediate cessation of a manic/depressive episode in some people.
There are numerous other examples of these issues in heart disease, cancer,
auto-immune diseases, and so forth.
The fact that microorganisms are becoming more resistant to treatment
and getting deadlier from improper management, combined with the fact
that many diseases are caused by unrecognized pathogens, means that
every individual needs to come to grips with evolutionary biology or risk
becoming a victim of it.
• Practically reads itself, January 05 2003
This book is extremely readable, and hard to put down. The authors make a
very compelling case for the usefulness of a evolutionary perspective in
medicine. I have a couple minor complaints (but don't let this discourage
you). The authors seem to move freely between fact and speculation, with-
out making clear distinctions. Not a problem if you're paying attention,
but they may sometimes give the impression that theire is more data to
support a contention than there actually is. Anyway, I highly recommend
this book - it's easy to read, stimulating, and bound to make you look at
illness and health in a new way.
• Stimulating Persepctives on Sickness, March 15 2002
" Why We Get Sick" is a discussion on novel way of thinking about sickness,
an epiphany on the perseverance of human vulnerability. The book
addresses where disease come from and why we get such diseases. Nesse
and Williams carefully state 6 major causes of diseases: Defenses, infection,
novel environments, genes, design compromises, and evolutionary legacies.
Our immune system is the frontier battefield of any intruders. Studies have
shown that at the first point of contraction, the immune system proliferate
T-cells against the HIV virus. These immune cells fight the best they can
to prohibit HIV settling onto the CD-4 cells. The only reason the immune
system loses is because the HIV virus is simply too smart that they mutate
into other forms and fool the T-cells. The first sign of the cold virus
triggers series of defensive action-fever and sneezing are actually not illness,
but defensive/immunological responses against the virus.
Bacteria can evolve as much in a day as we can in a thousand years, and
this gives us a grossly unfair handicap in the arms race. That's right,
according to the authors of this book, we are in an ever-lasting struggle
with bacteria and virus because they evolve so much faster than we can
imagine. TB disappeared more than 40 years ago after the discovery of
antibiotics. TB is now coming back with an even more potent form-a
kind that no longer can be treated by the old antibiotics. Evolution of
the virus plays a significant role here. The possibile treatment would be
 chemical mimetics, synthesizing structurally similar compound to treat
the new strain.
The more I read the more I'm refreshed by the authors. They discussed
the cause of allergy and why some people are so allergic to plants and
pollen while others are completely immune to them. The book also makes
distinction between virus and toxins. How does the body identify novel
toxins? What is the sinificance of maleness and femaleness? These are
questions we all address but of which we never consider in the evolutionary
point of view. The authors do not argue that evolution is the main cause of
why we have allergy, AIDS, influenza and gene defects, but they have done
a brilliant job in exploring the matter in this side of the argument.
• Review of. .. Why We Get Sick: The New Science of Darwinian Medicine,
by Randolph M. Nesse, MD and George C. Williams, PhD.
This very user-friendly book begins with a series of questions that I had
been asking for many years when I first picked it up: why do we get
sick? More exactly, "Why, in a body of such exquisite design, are there a
thousand flaws and frailties that make us vulnerable to disease?" I could
hardly believe that someone had written a whole book about this!
Nesse and Williams present an amazingly clear set of answers to questions
that I had almost completely given up any hope of answering in this life-
time. Through every chapter of the book, I found myself nodding and
slapping my forehead and saying, "Of course!" By the end, I actually felt
deeply satisfied, as though someone had put to rest a very old mystery for
me. I am very grateful to them for it.
"Darwinian medicine" is the secret ingredient, the scientific perspective
that makes the book work and provides such enlightening answers to oth-
erwise unapproachable questions. Nesse and Williams have spent a lot of
time figuring out how natural selection accounts for the delicate compro-
mises that constitute human physiology, the imperfections that are built
into the system. One peculiarity of human frailty after another is made
sensible. By the end of the book, I was accustomed to the unusual perspec-
tive and starting to apply it to even more questions. My understanding
of health has deepened substantially since then.
• (From Publisher's book back cover) The next time you get sick, consider
this before you pick up the aspirin: your body may he doing exactly
what it's supposed to. In this groundbreaking book, two pioneers of the
emerging science of Darwinian medicine argue that illness as well as the
factors that predispose us toward it are subject to the same laws of natural
selection that otherwise make our bodies such miracles of design. Among
the concerns they raise: When may a fever be beneficial?
Why do pregnant women get morning sickness precisely when they are
supposed to be nourishing their developing babies?
How do certain viruses "manipulate" their hosts into infecting others?

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 What evolutionary factors may be responsible for depression and panic
disorder?
Deftly summarizing the latest research on disorders ranging from allergies
to Alzheimer's, and from cancer to Huntington's chorea, Why We Get
Sick answers these questions and more. The result is a book that will
revolutionize our attitudes toward illness and will intrigue and instruct
lay persons and medical practitioners alike.

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