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Authors: Randolph M. Nesse

Why We Get Sick

BOOK: Why We Get Sick
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Acclaim for
Randolph ML Nesse and George C. Williams’s


“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

“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 discipline.”

The New York Times Magazine

“Every so often, a book comes along that has the power to change the way we live and die. This splendid book is one, and it could well revolutionize the way physicians 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

“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 their infants to prevent sudden infant death? You might after hearing how your prehistoric ancestors 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 … controversial, but that’s the point.”

Wall Street Journal

Why We Get 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

Why We Get Sick
offers both a provocative challenge to medicine and a thoughtful discussion of how evolutionary theory applies to people.”

Business Week

Randolph M. Nesse, M.D.
George C. Williams, Ph.D.

Randolph M. Nesse, M.D., is a practicing physician and professor and associate chair for education and academic affairs in the Department of Psychiatry at the University of Michigan Medical School.

George C. Williams, Ph.D., is a professor emeritus of ecology and evolution at the State University at Stony Brook and editor of
The Quarterly Review of Biology.


Copyright ©
1994 by Randolph M. Nesse, M.D., and George C. Williams, Ph.D

All rights reserved under International and Pan-American Copyright Conventions. Published in the United States by Vintage Books, a division of Random House, Inc., New York, and simultaneously in Canada by Random House of Canada Limited, Toronto. Originally published in hardcover by Times Books, a division of Random House, Inc., New York, in 1995.

Grateful acknowledgment is made to the following for permission to reprint previously published material:

Lawrence M. Crapo and James F. Fries, M.D.: Two charts from
Vitality and Aging
by Lawrence M. Crapo and James F. Fries, M.D.
(W. H. Freeman & Company, San Francisco, 1981).
Reprinted by permission.

Harcourt Brace &. Company: Chart 12-1 from
Life: An Introduction to Biology
by George C. Simpson, Colin S. Pittendrigh, and Lewis H. Tiffany. Copyright © 1957 by George C. Simpson, Colin S. Pittendrigh, and Lewis H. Tiffany. Copyright renewed 1985 by Anne R. Simpson, Joan Simpson Burns, Ralph Tiffany, Helen Vishniac, and Elizabeth Leonie S. Wurr. Reprinted by permission of Harcourt Brace & Company.

The Library of Congress has cataloged the Times Books edition as follows: Nesse, Randolph M.
Why we get sick: the new science of Darwinian medicine Randolph M. Nesse and George C. Williams.—1st ed.
p. cm.
1. Medicine—Philosophy. 2. Human evolution.
3. Human biology. 4. Adaptation (Physiology)
I. Williams, George C. (George Christopher), 1926– II. Title.
R723.N387 1995
610’.1-dc20 94-27651
eISBN: 978-0-307-81600-9

Illustrations by Jared M. Brown



ur work has benefited enormously from comments made by many colleagues and friends who know more than we do about certain aspects of medicine and evolution. We have not always had the sense to take their advice, so don’t blame them for our mistakes. Among those who have offered comments or other suggestions on the manuscript are: James Abelson, M.D., Ph.D., Laura Betzig, Ph.D., Helena Cronin, Ph.D., Lyubica Dabich, M.D., Wayne Davis, Ph.D., William Ensminger, M.D., Paul Ewald, Ph.D., Joseph Fantone, M.D., Rosalind Fantone, R.N., Robert Fekety, M.D., Linda Garfield, M.D., Robert Green, M.D., Daniel Hrdy, M.D., Sarah Hrdy, Ph.D., Matt Kluger, Ph.D., Isaac Marks, M.D., Steven Myers, M.D., James Neel, M.D., Ph.D., Margie Profet, M.A., Robert Smuts, M.A., William Soloman, M.D., Paul Turke, Ph.D., Alan Weder, M.D., Brant Wenegrat, M.D., and Elizabeth Young, M.D. For help in finding references we especially thank Doris Williams, Jeanette Underhill, M.D., and Joann Tobin. A sabbatical provided by The University of Michigan with support from John Greden, M.D., and George Curtis, M.D., made it possible for Randolph Nesse to work on the manuscript at Stanford University, where Brant Wenegrat, M.D., and Anne O’Reilly offered hospitality beyond measure. Barbara Polcyn’s loyal and effective secretarial support was wonderful. We are grateful to our agent, John Brockman, for convincing us that we could present serious new science in a book for a general audience and for handling negotiations and publishing details with great effectiveness, and to Barbara Williams for persuading us to take John Brockman seriously. The style and structure of the book are much improved thanks to detailed editing by Margaret Nesse and by our editor at Times Books, Elizabeth Rapoport.

Our greatest debt is to those who made us realize that we had a reason to write this book. They are the pioneers and visionaries whose ideas and investigations form the heart of the now flourishing field of Darwinian medicine. Some, like Paul Ewald and Margie Profet, figure prominently in several places in our text. Others are mentioned more briefly or merely have their publications listed in our endnotes. We are confident that, over the next few years, they will all be getting growing shares of the recognition they richly deserve.


e first met and discovered our shared interests in 1985 at a meeting of a group that later developed into the Human Behavior and Evolution Society. One of us (Nesse) was a physician in the Department of Psychiatry at the University of Michigan Medical School. Frustration with psychiatry’s lack of theoretical foundation and fascination with the extraordinary progress that evolutionary ideas had brought to the field of animal behavior had led to his association with the University of Michigan Evolution and Human Behavior Program. Colleagues in that interdisciplinary group, on hearing about his long-term interest in the evolutionary origins of aging, suggested a 1957 paper by a biologist named George Williams. The paper was a revelation. Aging had an evolutionary explanation. Why not anxiety disorders or schizophrenia? Thanks to subsequent years of conversations with evolutionists, especially Williams, and with medical school residents and faculty, he has found that an evolutionary perspective on patients’ disorders has become steadily more natural and useful.

The other author (Williams) has divided his career between marine ecological research and theoretical studies on evolution. His interest in medical applications of evolutionary ideas was aroused by reading a 1980 article by Paul Ewald in
The Journal of Theoretical Biology
, “Evolutionary Biology and the Treatment of the Signs and Symptoms of Infectious Disease.” Ewald’s work suggested that evolutionary ideas might well have significance for many medical problems, not just those that arise from infection. Williams’ general knowledge of evolutionary genetics included many principles with obvious implications for genetic diseases, and his early work on the evolution of the aging process suggested a basic relevance of evolution to gerontology.

We convinced each other, shortly after we met, that the potential contribution of evolutionary biology to medical progress was important enough to justify a real effort to bring this idea to others. We decided to put our reasoning and some obvious examples into print as a way of stimulating other workers to explore many other possibilities. After our jointly written article, “The Dawn of Darwinian Medicine,” published in
The Quarterly Review of Biology
in March 1991, drew a favorable reception from the press as well as colleagues in both medicine and evolutionary biology, we decided that it could easily be expanded into a book that would interest a wide range of readers.

Charles Darwin’s theory of natural selection as the explanation for the functional design of organisms is the foundation of almost everything in this book. The discussion centers on the concept of adaptation by natural selection: adaptations by which we combat pathogens, adaptations of pathogens that counter our adaptations, maladaptive but necessary costs of our adaptations, maladaptative mismatches between our body’s design and our current environments, and so on.

As we wrote, we kept discovering new ways in which Darwinism can aid the progress of medicine. We gradually realized that Darwinian medicine is not just a few ideas, but a whole new field, with exciting new developments arising at an ever-increasing rate. However, we must emphasize that Darwinian medicine is still in its infancy. The examples of Darwinian thinking applied to medical problems should not be taken as authoritative conclusions or medical advice. They are designed only to illustrate the use of evolutionary thinking in medicine,
to instruct people on how to protect their health or treat their diseases. This is not to say that we believe Darwinian medicine is merely a theoretical endeavor. Far from it! We have every expectation that the pursuit of evolutionary questions will demonstrably improve human health. That will require effort, money, and time. In the meanwhile, we hope this book will stimulate people to think about their illnesses in a different way, to ask questions of their doctors, perhaps even argue with them, but certainly not to ignore their instructions.

Having made that disclaimer, we will also make a few others. This book does not arise from a disapproval of current medical research or practice in Western industrialized nations. It is based on the conviction that medical research and practice would be even better if questions of adaptation and historical causation were routinely considered along with those of immediate physical and chemical causation. We are urging not an alternative to modern medical practice but rather an additional perspective from a well-established body of scientific knowledge that has been largely neglected by the medical profession. We would be very much against Darwinian medicine being viewed as a kind of alternative cult opposed to some supposed orthodoxy. It is likewise not our purpose to make political recommendations, although we believe that some of our reasoning might prove important to those who formulate health care or environmental policies.

BOOK: Why We Get Sick
4.04Mb size Format: txt, pdf, ePub

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