Too Much of a Good Thing

October 1, 2015
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 Otzi, 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.

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February 1, 2016

Obesity, high blood pressure, depression, and heart disease are leading causes of death in the United States today. The statistics are startling--more than one-third of Americans are obese and an additional one-third are overweight; approximately 30 percent of adults have high blood pressure; one in ten have depression; and more than 600,000 die every year from heart disease. Here Goldman (MD, Columbia Univ. Medical Ctr.) argues that each of these diseases has its roots in the basic needs of our prehistoric ancestors to eat, remain hydrated, evade danger, and stanch bleeding. These predecessors developed behaviors--calorie loading, salt cravings, anxiety, and rapid clotting--that helped them survive. Now, these behaviors result in serious health problems. Goldman writes persuasively about each of these traits, tying present problems to past instincts and weaving biological explanations with historical research. He expresses skepticism that humans can overcome these problems through behavior modification or natural genetic selection, but he is optimistic about future medical treatments, including surgery, medications, and gene therapy. VERDICT Recommended for a general audience, including readers of popular health literature such as Michael Pollan's The Omnivore's Dilemma.--Talea Anderson, College Place, WA

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December 15, 2015
When we were cavemen, it was important to seek out the quick energy of fat and sugar, hold on to our sodium, react quickly to danger, and have our blood clot efficiently. The fittest survive, and humans became physically wired to protect these tendencies. Today, however, according to Goldman, dean of health sciences and medicine at Columbia University Medical Center, these same tendencies are threatening our lives. Our search for fat and sugar has led to obesity and diabetes, too much sodium gives us high blood pressure, overreacting to threats leads to stress, and blood clots cause strokes and heart attacks. Goldman discusses each of these problems thoroughly, comparing our needs then and now. He presents a convincing case for the power of our genetics and explains why conquering these inclinations is so difficult. The doctor suggests ways to try to change behaviors to fight back, but he looks to genetic altering and future medical intervention as our best chance. Although sometimes a little technical, this is an interesting explanation for our current medical woes.(Reprinted with permission of Booklist, copyright 2015, American Library Association.)