TOO MUCH OF A GOOD THING

A renowned cardiologist explores the paradox that traits essential to human survival in prehistoric times are today the cause of countless human deaths.

Goldman (Dean, Health Sciences and Medicine/Columbia Univ. Medical School), the lead editor of Goldman-Cecil Medicine, “the oldest continuously published medical textbook” in the country, cites these traits as the ability to form blood clots to prevent bleeding to death, the ability (or tendency) to gorge when food was available to prevent starvation when it was not, the craving for salt and water to prevent fatal dehydration, and the hypervigilance needed to avoid a violent death. The author points out that the world that demanded these protective attributes has changed dramatically in recent centuries, and our genetic makeup cannot change rapidly enough to get our genes into synch with our environment. He expands on this theme in Part I with historical data, statistics, medical insights, and anecdotes about individuals as disparate as Franklin Roosevelt, Gen. George Custer, and Ötzi, the mummified Ice Age man. This highly readable section is packed with information about depression, obesity, and heart disease and strokes. Part II, however, turns from this expansive and detailed view of the problems to Goldman’s own views of the solutions. He considers two options for coping: harnessing willpower to change our behaviors and our lifestyles, an approach he views with considerable skepticism; or using brain power to change our biology, which means using modern science and medicine to help our bodies adapt to the modern environment. From his perspective, the precision approach of personalized medicine offers great hope, and he sees a future in which medications and procedures compensate for the failure of our genes to adapt rapidly or even alter the ways in which our genes work.

Part I gets kudos for being informative and accessible, but the presumptions of Part II make for a controversial conclusion.