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Human Nature Review 2002 Volume 2: 229-232 ( 11 June )
URL of this document http://human-nature.com/nibbs/02/boaz.html
Evolving Health: The Origins of Illness and How the Modern World is Making Us Sick
by Noel T. Boaz
John Wiley & Sons, 2002
Reviewed by Robert S. Corruccini, Professor, Department of Anthropology, Southern Illinois University, Carbondale, IL 62901-4502, USA.
Boaz’ book aims to impress the general public with an extreme evolutionary perspective on the historical and phylogenetic sources of human disease. The book’s distinction lies in the detailing of seventeen evolutionary levels or grades of organic life, first defined by increasing cellular complexity and later by specifically hominid evolutionary gradations. The causes and correlates of diseases can then be narrowed down to the disruption of adaptations occurring at certain levels, and the approach is often (although not always) productive epidemiologically for inferring etiologies.
Early on, Boaz states that “Evolutionary Medicine” is an important perspective and the prescribed focus of his reasoning (p. 3). Thereafter there are only scattered and scant references to specific parts of the canonical writings of this specialty (e.g., Trevathan et al., 1999; Eaton et al., 1988) but Boaz does not dwell on the intellectual debt owed this school of thought. The Chapter 1 footnotes do not cite “Evolutionary Medicine” or the “Paleolithic Prescription”. There is Burkitt but not cited for his and Trowell’s seminal definition of Western Diseases (nor acknowledgment of the Epidemiological Transition concept), and a Konner reference but not to the present volume’s predecessor, “The Paleolithic Prescription”. Instead Boaz continually refers to the outmoded phrase “diseases of civilization”. And although subscribing to many of the preventive health benefits of the Paleolithic Prescription, Boaz nevertheless advises “consult your physician” which doesn’t always fit in the Evolutionary Medicine framework (Boaz and his spouse are both M.D.’s).
Many of the book’s points are excellent and would yield delight if effectively delivered to the public and to the clinical specialists. The feast-or-famine “thrifty genotype” concept gets a good treatment (p. 6). The chapter on diabetes is very good. Pages 78-94 on cancer causes are important. Cellular insult and immune system impairment are detailed in their relation to cancer, undeniably true, but how does this assist in explaining the clumping of such damaged cells into tumors? Boaz’ theory calls for cells to revert to an earlier, all-for-one tendency from protozoan days to explain cancer but this doesn’t explain their coalescence. The allusion on pp. 89 and 91 to excess menstrual cycles (a modern abnormality) in etiology of female breast and ovarian cancer is valid, and could have mentioned also the possible relationship to osteoporosis and even PMS. Boaz relates prostate cancer to untreated benign prostate hyperplasia (p. 94) but I thought there was actually a faint inverse relation, and he does not discuss evolutionary implications of higher African American prostate cancer mortality. Evolutionary Psychology is effectively woven into the chapter on evolution of psychiatric disorders, although Boaz (p. 192) omits the evidence of schizophrenia being a second trimester insult rather than genetically innate.
On p. 14 we encounter a gem of evolution-based reasoning. “The stunning accomplishment of sequencing the human genome.... will not resolve the scourge of modern medicine.... These are diseases caused not by single gene defects but by.... ‘modern’ conditions.... Hopefully (sic), this understanding will help teach us how genes function WHEN WE ARE HEALTHY (emphasis mine), rather than only how they cause disease.” A better retort to the Human Genome Project (see also p. 113) and its ill-conceived hopes could hardly be voiced.
The description of diverticulitis and appendicitis as roughage deficiency related modern diseases (p. 170) is excellent but again they are described as “diseases of civilization.” I do not suppose early Sumerians or Chinese state-level inhabitants had much of this. Rather, these are diseases of modern industrialization. Roughage plus a squatting posture for defecation are convincing negative correlates of hemorrhoids also, although Boaz (p. 12 and p. 156) ascribes hemorrhoids to sedentary habits, sitting, and gravity.
Many professionals will be surprised to learn that cancer owes to human phylogenetic ancestry from sponges, that salt is related to heart disease and this sodium excess derives from fish ancestry, that cumulative mutagens (not mother’s aging) lead to Down’s syndrome (p. 48), that cystic fibrosis (p. 56) results from adaptation to diarrhea (not tuberculosis?), that our human hairlessness relates to parasite resistance rather than thermoregulation (p. 64), that our shared ancestry with insects explains our tendency to become addicted to tobacco (p. 116), that canines are masticatory teeth in apes, and incisors become smaller in humans for meat eating (p. 163), and that mollusks are related to insects (p. 203).
Too exuberant an adherence to evolutionary orthogenetic determinism is indicated by stating eukaryote cells “discovered” (p. 28) that there was safety in numbers, a sort of metazoan destiny; Miocene “hominoids underwent several genetic mutations that allowed them to conserve water” (p. 37); and the morula is “homologous” to the sponge level of multicellularity. There is such a thing as being excessively evolutionistic, and on p. 43 throwbacks to fish and amphibian stages to explain birth defects are contradicted by various futuristic possibilities such as fused fingers, Down’s syndrome, hydrocephaly, bipolar disorder, and tooth agenesis.
Coronary heart disease being among major causes of mortality in the West, Boaz’ version of its evolutionary causes deserves special scrutiny. On pp. 97-104 he sees innovation of the kidney and succeeding tendency to hypertension (high blood pressure) as forerunners of coronary heart disease and plaque. There is precious little discussion of the relation of these conditions to cultural oppression (American Blacks) or to inactive high-cholesterol habits (witness the low heart disease rate in non-industrialized populations).
I have a special quibble with Boaz’ exposition on admittedly rampant lower back pain (pp. 2, 37). He reiterates the timeworn anthropological explanation that “incomplete” (p. 149) adaptation to upright bipedalism causes back troubles, denying to otherwise omnipotent selection the ability to craft an adequate adaptation over 4+ million years. On p. 151 Boaz somewhat contradicts himself when admitting back pain is a disease of sitting (opposite of bipedalism), and hunter-gatherers do not have it. The predisposition to slipped discs is negatively related to the evolutionarily correct squatting posture, and the cross-cultural epidemiology here could have been better.
Boaz propounds a variant of the Paleolithic Prescription diet without saying so. He promotes establishment of adaptive normality (pp. 198-205) by eating insect chitin (shrimp shells?). He must be getting whimsical when advocating eating garden pests instead of using insecticide, eating low fat roadkill, etc. Does frivolity arise when he inveighs against oatmeal and barley proponents with his censure (also p. 96) against cereals and grains? Boaz advocates bacon for part of the diet to constitute 20-25% fat in the diet. My joke to biomedical classes for years has been that bacon is the perfect food for the Big Three Western diseases: nitrates (smoked) for cancer, sodium (salt preserved) for hypertension, and excess cholesterol for heart disease. Surely our immobile and overfed farm animals lay down the fats that we immobile and overfed humans derive from them for our Western Diseases.
Humans indeed need not deteriorate with age (pp. 221-2), but there are no key references (e.g., Crews, Beall) cited for this. Indeed, in one group, Yucatec Maya, the traditional rural component shows little of the age-progressive hypertension and rising serum sugars (Kelley, 19-86 McLorg, 2000), shows a reduced heritability (family tracing) of high blood pressure (Kelley, 1986), and a completely different pattern of lower back pain (D. Smerken, 1994) together with a health-positive pattern of bilirubinemia (neonatal jaundice: M. Smerken, 1995) when contrasted with their genetically equivalent modernized urban Maya counterparts or with Americans.
All the proponents of “Evolutionary Medicine” are missing a good bet when neglecting the evidence of non-fatal minor disorders such as dental malocclusion and visual refractive error, vital to the concept of “normalcy” (p. 197). More than half of modern Western people have crooked teeth judged as needing orthodontic intervention (many less receive it due to economic constraints), and more than 50% of industrialized persons need refractive adjustment through lenses. Boaz attributes myopia to degeneration (self-domestication: p. 179) which is an old and disproven genetic etiology for both visual and dental anomalies (Corruccini, 1999), yet these anomalies are much closer to the “norm” for modernized people than to being an aberration. Could aboriginals have survived with such impediments more than 20,000 years ago? A majority of living modern people are relevant to the answer, which contrasts with the relatively few victims of the fatal diseases. True, the latter are more terminal, but the former have more to say about what afflicts the majority of us all, and they yield more statistical explanatory power. Both syndromes also demonstrate much false heritability through environmental covariance, just as with IQ (Devlin et al., 1997).
One can only hope that “Evolving Health” and its worthwhile messages will impact the appropriate specialties.
Corruccini, R. S. (1999). How Anthropology Informs the Orthodontic Diagnosis of Malocclusion’s Causes. Lewiston: Mellen.
Devlin, B., Fienberg, S. E., Resnick, D. P., and Roeder, K. (Eds.) (1997). Intelligence, Genes, and Success. New York: Copernicus (Springer-Verlag).
Eaton, S. B., Shostak, M., and Konner, M. (1988). The Paleolithic Prescription: A Program of Diet and Exercise and a Design for Living. New York: Harper and Row.
Kelley, J. C. H. (1986). Blood Pressure in Juvenile Yucatec Maya: Maturation, Urbanization and Familial Tendency. Ph.D. Dissertation, Southern Illinois University at Carbondale.
McLorg, P. A. (2000). Aging and Glycemia in a Nonwesternized Context: Rural Maya Females in Yucatan, Mexico. Ph.D. Dissertation, Southern Illinois University at Carbondale.
Smerken, D. S. (1994). A Cross-Cultural Epidemiological Study of Low Back Pain in American and Yucatec Maya Adult Males. Ph.D. Dissertation, Southern Illinois University at Carbondale.
Smerken, M. J. (1995). A Cross-Cultural Epidemiological Study of Physiologic Jaundice in American and Yucatec Maya Infants. Ph.D. Dissertation, Southern Illinois University at Carbondale.
Trevathan, W. R., Smith, E. O., and McKenna, J. J. (Eds.) (1999). Evolutionary Medicine. New York: Oxford.
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© Robert S. Corruccini.
Robert S. Corruccini is Professor of Anthropology at Southern Illinois University, Carbondale. Among the subdisciplines of Biological Anthropology, Dr. Corruccini publishes research particularly concerning Human Dental Variation, Epidemiology of Malocclusion, the Evolution of Disease, Morphometrics and Statistics with special reference to concepts of shape, and various aspects of Primate and Hominid Evolution. Dr. Corruccini is author of How Anthropology Informs the Orthodontic Diagnosis of Malocclusion's Causes, Edwin Mellen Press, 1999; co-author with Samvit S. Kaul of Halla, University Press of America, 1990, and co-editor with Russell L. Ciochon of New Interpretations of Ape and Human Ancestry, Plenum, 1983, and Integrative Paths to the Past: Paleoanthropological Advances in Honor of F. Clark Howell, Prentice Hall, 1994.
Corruccini, R. S. (2002). Review of Evolving Health: The Origins of Illness and How the Modern World is Making Us Sick by Noel T. Boaz. Human Nature Review. 2: 229-232.