Survival of the Sickest: The Surprising Connections Between Disease and Longevity.
Article Type:
Book review
Books (Book reviews)
Moses, Allen J.
Kittay, Irving
Pub Date:
Name: CRANIO: The Journal of Craniomandibular Practice Publisher: Chroma, Inc. Audience: Academic Format: Magazine/Journal Subject: Science and technology Copyright: COPYRIGHT 2009 Chroma, Inc. ISSN: 0886-9634
Date: Jan, 2009 Source Volume: 27 Source Issue: 1
NamedWork: Survival of the Sickest: The Surprising Connections Between Disease and Longevity (Nonfiction work)
Reviewee: Moalem, Sharon; Prince, Jonathan

Accession Number:
Full Text:
Survival of the Sickest: The Surprising Connections Between Disease and Longevity

Sharon Moalem, with Jonathan Prince

Harper Perennial, New York, 2007

372 pp., $13.95 paperback

ISBN: 978-0061232961


The title, Survival of the Sickest, is certainly an attention grabber. The author is presumably disputing Charles Darwin's evolutionary precept, survival of the fittest. The cover features a quote from a review of the book by Dr. Mehmet Oz, saying this book, "challenges everything we thought we knew about disease." The book indeed questions accepted common knowledge. Sharon Moalem is up to the task of explaining these new concepts. Briefly, his thesis is that certain nonfatal genetic changes can engender negative metabolic alterations making the organism weaker but less susceptible to other acute life-threatening diseases and thus ensuring their survival. Sometimes the stories are tortuous and circuitous, but the author ties all the ends together at the close of the chapters.

Dr. Moalem discusses hemochromatosis, a hereditary disease that relates to iron metabolism. He explains its symptoms, its pathophysiology, the relationship of iron metabolism to other maladies and the body's overall resistance mechanism relative to homochromatic macrophages. He concludes this chapter by detailing how people with the hemochromatosis mutation were much less likely to die from bubonic plague in the middle ages, and thus explains the survival benefit of one potentially harmful gene.

He further relates the scientific benefits of bloodletting as current medical treatment, and the harmful effects of excess dietary iron supplements. In another chapter he tells the story of how diabetes may have helped our ice age ancestors manage the extreme cold.

Four hundred million people have favism, the most common inherited enzyme deficiency in the world. People with favism who eat lava beans experience rapid, severe anemia that can sometimes be fatal. Primaquine, an anti-malaria drug, has the same effect based on the same gene (GP6D) in people of color of African descent. GP6D deficiency also relates to sickle cell anemia. The red blood cells of people with favism or sickle cell anemia are taken out of circulation sooner, and thus disrupt the life cycle of the parasitic protozoa that causes malaria or sickens people. People with favism, GP6D deficiency, or sickle cell anemia, have a significant measure of protection from malaria.

Two chapters in particular make this book worthwhile, Jump Into the Gene Pool and Methyl Madness: Road to the Final Phenotype.

Jump Into the Gene Pool is a review of genetics, current genome concepts such as junk DNA, theories of genetic recombination, knockout gene experiments, scientific revivication of Lamarkian Theory, transporons or jumping genes, endogenous retroviruses, and parasitic viruses as the sparks of evolution. It provides a wonderful explanation of contemporary genetic theory and links together all of the above concepts.

Methyl Madness deals with the concept of epigenetics. Epigenetics is concerned with the study of how children can inherit and express new traits from their parents without changes in their DNA. Prenatal maternal nutrition can profoundly alter gene expression without altering the genes themselves. The exact same genes can produce different outcomes depending whether they have undergone methylation or not. The existence of both maternal and paternal methylation effects have been demonstrated. Epigenetic changes have been shown to pass through the germ line for many generations.

This information is relevant to dentists. Prenatal nutrition counseling can have profound effects. Postnatal interaction between mothers and their offspring have also been shown to provoke the placement of methyl markers that cause significant epigenetic changes. It has been demonstrated that breast feeding is good for children. Cognitive, facial, and physical development are positively affected. Attention and touch have been shown to improve a child's response to stressful situations. They can actually change the expression of a baby's genetic code.

The point of this book is that our relationship with disease is much more complex than previously thought (craniomandibular practitioners already knew this) and that evolution as we now understand it, based on advances in neurogenetics, epigenetics, and methylation may occur in the time frame of years rather than millennia. Our understanding of these new developments can significantly impact our lives, those of our children as well as the way we practice. We highly recommend this fascinating book.

Allen J. Moses D.D.S., and Irving Kittay, D.D.S.,
Gale Copyright:
Copyright 2009 Gale, Cengage Learning. All rights reserved.