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

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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.

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Editorial Reviews

From Barnes & Noble
This fascinating book was prompted by one nagging question: Why hasn't evolution rooted out all the debilitating hereditary diseases that still plague us? Neurogenetics specialist Dr. Sharon Moalem thinks that he knows the answer. According to him, diabetes, hemochromatosis, cystic fibrosis, and sickle cell anemia exist because each offers evolutionary advantages to offset its negative consequences. He asserts, for instance, that diabetes might be the byproduct of a mechanism that helped humans survive the Ice Age. Survival of the Sickest also helps explains why African Americans living in northern climes might suffer from vitamin D deficiencies and why Asians have a lower tolerance for alcohol than Europeans.
Body + Soul
“[a] fascinating new book...[Moalem] has a way of turning complicated biology into captivating stories.”
Rocky Mountain News
“fascinating, enlightening and reader-friendly...This is one not-to-be-missed fantastic journey across the evolutionary landscape of humankind.
Edmonton Journal (Alberta)
“CSI meets Freakonomics meets Bill Nye the Science Guy.”
Publishers Weekly
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.) Copyright 2006 Reed Business Information.
Library Journal

History does not always receive a great deal of attention in the scientific disciplines, yet this book shows us exactly why it shouldn't be ignored, even in the more analytical areas of genetics and medicine. Moalem (Ph.D., neurogenetics & evolutionary medicine) uses numerous examples to show how analyzing history might help explain why a certain genetic trait that seems useless—even harmful—to us now made perfect sense in our ancestors' environment. He also introduces such recent research topics as host manipulation, noncoding DNA, and epigenetics. The particularly coherent writing style makes complex ideas accessible to people without a science background. With the book's emphasis on evolution's goals of survival and reproduction, readers will gain insights into why evolution may have selected for certain traits and why having that insight may better our lives. Highly recommended for general audiences. [See Prepub Alert, LJ6/15/06.]
—Tina Neville Copyright 2007 Reed Business Information

Kirkus Reviews
Certain disease-related genes may make you sick but protect you from a worse fate-death-argues unconventional medical researcher Moalem. Currently completing his training at Mount Sinai School of Medicine (he already has a Ph.D. in neurogenetics and evolutionary medicine), the author includes many examples to support his contention that "one man's disease is another man's cure." People with a genetic tendency for sickle-cell anemia, for example, have better natural resistance to malaria. Moalem provides evidence that a hereditary condition called hemochromatosis, which causes iron to build up in the body, may have arisen to protect people from plague and that vulnerability to diabetes may have been an adaptation to ice ages. The accumulation of sugar in blood made more concentrated by frequent urination lowers the freezing point so people don't freeze to death, he asserts. Dark-skinned people moving to northern climates may be more susceptible to heart disease because they carry genes for the excess cholesterol they needed in areas of intense sunlight. Other sections describe how plants and animals co-evolve as they adapt to climate changes and how a parasite like the Guinea worm "manipulates its victims to collaborate in the infection of others." We should use such knowledge to develop new strategies to defeat parasites rather than relying on drugs, Moalem suggests. He sees hope for ways to combat cancer that involve turning on or off selected genes-indeed, he has much to say about the dynamism of the human genome. The final chapters report research suggesting that environmental events in early pregnancy may have far-reaching effects on offspring. The author also takes seriously ElaineMorgan's idea that human evolution may have involved an aquatic phase. Moalem's lively and enthusiastic treatise offers enough plausible explanations for interesting phenomena that you'll be willing to forgive its more outre speculations. Agent: Tracy Fisher/William Morris Agency
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Product Details

  • ISBN-13: 9780060889654
  • Publisher: HarperCollins Publishers
  • Publication date: 2/6/2007
  • Pages: 288
  • Product dimensions: 6.30 (w) x 9.10 (h) x 1.00 (d)

Meet the Author

Dr. Sharon Moalem is an award-winning neurologist and evolutionary biologist, with a PhD in human physiology. His research brings evolution, genetics, biology, and medicine together to explain how the body works in new and fascinating ways. He and his work have been featured on CNN, in the New York Times, on The Daily Show with Jon Stewart, on Today, and in magazines such as New Scientist, Elle, and Martha Stewart's Body + Soul. Dr. Moalem's first book was the New York Times bestseller Survival of the Sickest. He lives in New York City.

Jonathan Prince was a senior adviser and speechwriter in the Clinton White House and oversaw communications strategy at NATO during the war in Kosovo. He was named one of America's Best and Brightest by Esquire in 2005 for his work to improve political advertising. With former U.S. senator John Edwards and Edwards's daughter Cate, Prince edited Home: The Blueprints of Our Lives.

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Read an Excerpt

Chapter One

Ironing it Out

Aran Gordon is a born competitor. He's a top financial executive, a competitive swimmer since he was six years old, and a natural long-distance runner. A little more than a dozen years after he ran his first marathon in 1984 he set his sights on the Mount Everest of marathons—the Marathon des Sables, a 150-mile race across the Sahara Desert, all brutal heat and endless sand that test endurance runners like nothing else.

As he began to train he experienced something he'd never really had to deal with before—physical difficulty. He was tired all the time. His joints hurt. His heart seemed to skip a funny beat. He told his running partner he wasn't sure he could go on with training, with running at all. And he went to the doctor.

Actually, he went to doctors. Doctor after doctor—they couldn't account for his symptoms, or they drew the wrong conclusion. When his illness left him depressed, they told him it was stress and recommended he talk to a therapist. When blood tests revealed a liver problem, they told him he was drinking too much. Finally, after three years, his doctors uncovered the real problem. New tests revealed massive amounts of iron in his blood and liver—off-the-charts amounts of iron.

Aran Gordon was rusting to death.

Hemochromatosis is a hereditary disease that disrupts the way the body metabolizes iron. Normally, when your body detects that it has sufficient iron in the blood, it reduces the amount of iron absorbed by your intestines from the food you eat. So even if you stuffed yourself with iron supplements you wouldn't load up with excess iron. Once your body is satisfied with the amount of iron it has, the excess will pass through you instead of being absorbed. But in a person who has hemochromatosis, the body always thinks that it doesn't have enough iron and continues to absorb iron unabated. This iron loading has deadly consequences over time. The excess iron is deposited throughout the body, ultimately damaging the joints, the major organs, and overall body chemistry. Unchecked, hemochromatosis can lead to liver failure, heart failure, diabetes, arthritis, infertility, psychiatric disorders, and even cancer. Unchecked, hemochromatosis will lead to death.

For more than 125 years after Armand Trousseau first described it in 1865, hemochromatosis was thought to be extremely rare. Then, in 1996, the primary gene that causes the condition was isolated for the first time. Since then, we've discovered that the gene for hemochromatosis is the most common genetic variant in people of Western European descent. If your ancestors are Western European, the odds are about one in three, or one in four, that you carry at least one copy of the hemochromatosis gene. Yet only one in two hundred people of Western European ancestry actually have hemochromatosis disease with all of its assorted symptoms. In genetics parlance, the degree that a given gene manifests itself in an individual is called penetrance. If a single gene means everyone who carries it will have dimples, that gene has very high or complete penetrance. On the other hand, a gene that requires a host of other circumstances to really manifest, like the gene for hemochromatosis, is considered to have low penetrance.

Aran Gordon had hemochromatosis. His body had been accumulating iron for more than thirty years. If it were untreated, doctors told him, it would kill him in another five. Fortunately for Aran, one of the oldest medical therapies known to man would soon enter his life and help him manage his iron-loading problem. But to get there, we have to go back.

Why would a disease so deadly be bred into our genetic code? You see, hemochromatosis isn't an infectious disease like malaria, related to bad habits like lung cancer caused by smoking, or a viral invader like smallpox. Hemochromatosis is inherited—and the gene for it is very common in certain populations. In evolutionary terms, that means we asked for it.

Remember how natural selection works. If a given genetic trait makes you stronger—especially if it makes you stronger before you have children—then you're more likely to survive, reproduce, and pass that trait on. If a given trait makes you weaker, you're less likely to survive, reproduce, and pass that trait on. Over time, species "select" those traits that make them stronger and eliminate those traits that make them weaker.

So why is a natural-born killer like hemochromatosis swimming in our gene pool? To answer that, we have to examine the relationship between life—not just human life, but pretty much all life—and iron. But before we do, think about this—why would you take a drug that is guaranteed to kill you in forty years? One reason, right? It's the only thing that will stop you from dying tomorrow.

Just about every form of life has a thing for iron. Humans need iron for nearly every function of our metabolism. Iron carries oxygen from our lungs through the bloodstream and releases it in the body where it's needed. Iron is built into the enzymes that do most of the chemical heavy lifting in our bodies, where it helps us to detoxify poisons and to convert sugars into energy. Iron-poor diets and other iron deficiencies are the most common cause of anemia, a lack of red blood cells that can cause fatigue, shortness of breath, and even heart failure. (As many as 20 percent of menstruating women may have iron-related anemia because their monthly blood loss produces an iron deficiency. That may be the case in as much as half of all pregnant women as well—they're not menstruating, but the passenger they're carrying is hungry for iron too!) Without enough iron our immune system functions poorly, the skin gets pale, and people can feel confused, dizzy, cold, and extremely fatigued.

Iron even explains why some areas of the world's ocean are crystal clear blue and almost devoid of life, while others are bright green . . .

The foregoing is excerpted from Survival of the Sickest by Sharon Moalem, and Jonathan Prince. All rights reserved. No part of this book may be used or reproduced without written permission from HarperCollins Publishers, 10 East 53rd Street, New York, NY 10022
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Customer Reviews

Average Rating 4.5
( 55 )
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See All Sort by: Showing 1 – 20 of 55 Customer Reviews
  • Anonymous

    Posted November 1, 2011

    Fun read for teenagers too!

    I was forced to read this book by my AP Biology teacher, but I'm glad she did! Moalem has a funny, sarcastic tone and a diction that is unlike a science journal, which has the boring fancy writing. This book gets straight to the point about diseases and genetics. And I actually want to read it again, as do other people in my class!

    4 out of 4 people found this review helpful.

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  • Posted March 17, 2010

    more from this reviewer

    one of my favorites!

    This book is without a doubt amazing. It brings science into our everyday world and more importantly it makes science easy to understand. With every scientific explanation goes an interesting example in our lives today. One that I found incredible was our evolutionary need for diabetes. The author goes into the science of it and how our ancestors lived in an ice age and how to help keep their tissues and organs from freezing they developed diabetes. The sugar in our blood helps prevent our cells from freezing. Pay attention this is my favorite part! After explaining this, much better might I add, the author talks about the whole idea of sugar preventing freezing can be seen in our everyday slurpees that you get at a gas station! If you removed the sugar from a slurpee you would just have a block of ice! AMAZING!

    3 out of 3 people found this review helpful.

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  • Posted October 25, 2008

    more from this reviewer

    a bit scientific....

    Survival of the Sickest is an interesting and thought provoking book about disease. The author takes a handful of diseases, for example diabetes and favism, and looks at them from an evolutionary perspective. She shows how some of the diseases we have today might have actually been a good thing for our ancestors. "Evolution likes genetic traits that help us survive and reproduce-it doesn't like traits that weaken us or threaten our health (especially when they threaten it before we can reproduce)." If diabetes helped our ancestors survive the last ice age, those genes would have been passed on in reproduction. Dr. Moalem definitely makes sense in Survival of the Sickest. It gets a bit scientific in parts though and a little hard to digest. After reading this book I won't look at hereditary disease in quite the same way.

    3 out of 3 people found this review helpful.

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  • Anonymous

    Posted May 27, 2008

    Fascinating work

    As a genealogist, and an armchair geneticist, this was a fascinating read. It's data was entertaining and easily accessible. A rare find.

    3 out of 3 people found this review helpful.

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  • Posted August 11, 2011


    Wow, what a wonderful book. It makes you rethink every genetic trait and disease that ever plagued the human race in recent memory, in an evolutionary context. I read this for my Advanced Biology class and it still stands out as one of my all-time favorites.

    2 out of 2 people found this review helpful.

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  • Posted March 18, 2011

    Great Book; Especially if you have Hemochromatosis

    I loaned my copy to a friend and as usually, you don't often get loaned copies back. I now have a Nook and am thinking of buying this book again as a Nookbook. One great thing about this book is its index. As a person with Hemochromatosis, the book is greatly appreciated. But even if you don't have this genetic disorder, it is still worth reading since it talks about such things as Vitamin D and its relation to cholesterol and brown fat which helps Eskimos keep warm in a frozen climate. Then there are chapters that deal with reptiles that have different tails if certain predators such as snakes are in the vicinity. Again, a great book.

    2 out of 2 people found this review helpful.

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  • Anonymous

    Posted April 7, 2013

    G Interesting and factual

    It was hard to put this book down, it covers topics of diabetes, malaria, and more. It includes why diseases are still in the gene pool and how they can be helpful for our survival.

    1 out of 1 people found this review helpful.

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  • Posted August 18, 2011

    Survival of the Sickest

    File is curropted and cannot be read in any eReader. My Nook for PC can't read it either.

    Please check the file and re-post it for downloading. Tahnks.


    1 out of 2 people found this review helpful.

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  • Posted June 17, 2011

    As a biology teacher, this book gave me more insight into genetic disorders and adds to your arsenal of responses for the never ending "why's?" It even answered many of my own.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted March 12, 2010

    This Book is very interesting!

    It is facinating to find out how some of the health problems that plague us today may have evolved within us. She explains where high blood pressure came from, why some people are lighter then others, etc. If you interested in the evolution of genetic diseases then this is the perfact book!

    1 out of 1 people found this review helpful.

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  • Posted May 25, 2009

    Excellent book, well written

    I have a limited background in science, but this book was very clear and easy to understand. I particularly enjoyed his discussion of epigenetics. I recommend this book for just about anyone, no matter what field they are in. I give it five stars, its an excellent book. I also plan to read Dr. Moalem's next book that is coming out soon.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted January 23, 2015

    Highly informative, without being indecipherable

    Dr. Moalem does very well in explaining scientific concepts in layman's terms. I do admit that he tends to jump around a bit; however, he also does very well at tying all of his seemingly random tangents together.
    I'm pretty sure that I'd enjoy this book even if I did not have the background in the study of biology and genetics that I do.

    Definitely recommend it for anyone curious about disease and its evolution.

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  • Posted January 4, 2015

    Survival of the Sickest by Dr. Sharon Moalem takes the reader th

    Survival of the Sickest by Dr. Sharon Moalem takes the reader through a different point of view on disease and life as we know it.  It answers questions one didn’t even know they had when talking about evolution and disease.  It is very well written and easy to follow.  The purpose of the book is to explain why diseases are vital to our specie’s evolution, why some diseases are still around today, and why some diseases died out with our ancestors.  It starts of telling the story of an ill grandfather and a very intrigued and determined young grandson who spent countless hours at the library looking through medical research books for an answer.  Once he reaches a conclusion on that quest, another illness pops up in his grandfather so his grandson begins searching for a connection between the two.  This lead to his choice to study biology in college and eventually earn a Ph.D..  By analyzing and comparing complex and intricate gene sequences, he figured out a connection.  He also traces the roots of many types of diseases such as diabetes, hemochromatosis, and STDs.  He also conducted research on genetic diseases, cholesterol, and gene expression.  A quote to sum up the book would be found in the conclusion stating, “I hope that you’ll come away from this book with an appreciation of three things.  First, that life is in a constant state of creation.  Evolution isn’t over- it’s all around you, changing as we go. Second, that nothing in our world exists in isolation.  We- meaning humans and animals and plants and microbes and everything else- are all evolving together.  And third, that our relationship with diseases is often much more complex than we may have previously realized.”

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  • Anonymous

    Posted December 14, 2010


    interesting, educational and easy to digest without being verbose.

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  • Posted January 11, 2010

    Eye Opening

    When ever I go to my doctor I think that being sick is bad or haveing an illness is bad. This book made me think differently. This book made me realize that some illnesses are helpfull to survival at certain times.

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  • Posted June 18, 2009


    Great read

    0 out of 1 people found this review helpful.

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  • Anonymous

    Posted May 31, 2009

    Survival of the Sickest

    Dr Sharon Moalem has some very interesting ideas! She has taken things that are well known, looked at them from a different angle and come up with some new twists. I found them to be compelling and logical. More things are related than people realize.

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  • Posted February 23, 2009

    eye opener

    I was astounded by this book and the revelations it contains. I am in the health profession and I never realized the genetic changes that occured thousand of years ago that "caused" conditions we consider diseases now. For example, Diabetes occured to help the people of the time to survive the cold. Too bad I won't be around in another thousand years to see if the diabetes genetic change changes again.

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  • Posted February 16, 2009

    I Also Recommend:

    Evolution has left us pluses and minuses in our health; here's a convoluted tour

    Why do many of us humans have debilitating genetic diseases, including sickle cell anemia, excess blood iron (hemochromatosis), and a susceptibility to paralysis from eating common fava beans? Author Moalem, a physiologist and soon-to-be physican, recounts the protective role that these conditions have afforded against other hazards, such as hemochromatosis helping against bloodborne bacterial infections. The stories are complex, and he tells them in even more complex fashion, with many digressions. This can be maddening at times, but the topics introduced along the way have some interest in themselves. <BR/> Each genetic disease - or disease susceptibility, in some cases - is introduced with a story of an individual, to add personal interest. By the way, my first sentence is misleading. He does not discuss sickle cell anemia, for which the full condition is lethal, while the heterozygous condition protects against malaria (that's the case when only one of our two genes coding for hemoglobin has the variant form). Moalem goes into some deep and interesting genetics. The most novel part of the book for most readers is probably the story of DNA methylation. This is the modification of our DNA post-facto to make some of it less readable than the rest. It acts as a second level of genetics and is linked to trends in obesity, brain development, and hypertension...and it's something that we can affect ourselves, for better or worse. <BR/> Moalem's chapter, "That's Life: Why You and Your iPod Must Die," synthesizes facts that have been known for some years, while being an eye-opener for most people. A bit of larger context is missing, which other writers have termed something like "death is the price of sex." Sexually-reproducing organisms, like humans and unlike, say, bacteria, have lots of built-in protections against changes in environmental conditions, from having two copies of each gene (a bit more complex, but it's a good summary). We avoid the accumulation of bad mutations, and we can grow into complex organisms with diverse capabilities...but we can't reproduce by fission as do bacteria. We have to mate and die. Would you want to last that much longer, anyway? Moalem details why we do "run down" and wear out, to the cellular level. The story is incomplete, at least, from my perspective, in that it doesn't cover non-genetic damage (e.g., progressive loss of our ability to handle oxygen safely in our cellular metabolism) as contributory to the finitude of our lifespan. Moalem does cover the "nicety" that a limit on reproduction by our individual cells is a potent, if incomplete, protection against cancer. <BR/> Overall, the book is a good read, a page turner. It may lead you to a healthier lifestyle, and certainly to several hours of high-level amusement.

    0 out of 1 people found this review helpful.

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  • Posted November 1, 2008

    I Also Recommend:

    Who knew diseases could be so beneficial?!

    Your disease could save your life! This book is easy to read and very informative. Survival of the Sickest describes how evolution has favored certain diseases in order to ensure survival of the species.

    Was this review helpful? Yes  No   Report this review
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