822 NOVEMBER-DECEMBER 2016 • VOL. 48, NO. 10 FAMILY MEDICINE
BOOK AND MEDIA REVIEWS
political forces at play in those recommenda-
tions. In many ways this book points out that
the simplest to recommend, inexpensive, but
often hard for the patient to engage in recom-
mendations such as lifestyle modifications are
often still where we should be focusing our
efforts. The more we can educate the public
about the complexity of back pain and the lack
of easy and quick solutions the more we will be
able to engage our patients in treatment, and
this book adds to that education. Watch Your
Back is a thoughtful and engaging book that
makes a good read for anyone involved in the
treatment of chronic back pain.
Jill Schneiderhan, MD
University of Michigan
The Story of the Human Body:
Evolution, Health and Disease
Daniel E. Lieberman
New York, NY, Pantheon Books, 2013, 480 pp., $27.95, hardcover,
New York, NY, Vintage Books, 2014, 480 pp., $15.95, paperback
Daniel Lieberman is the
chair of the Department of
Human Evolutionary Biol-
ogy at Harvard and is well
acknowledged for his talent
of transforming complex
evolutionary topics into un-
derstandable and interest-
ing vignettes.In The Story
of the Human Body, Lieber-
man outlines how human
evolution has provided us many advantages
but has also incurred certain disadvantages
related to our cultural adjustments over the
most recent few thousand years. Indeed, many
of our chronic illnesses are related to these
cultural alterations and have created what
Lieberman calls “dysevolution,” where symp-
toms are treated to a much greater extent than
the root cause of the problem. This is what
reverberates with me as I talk with patients,
residents, and medical students. Although it
is cliché to say, “That’s just an average over-
weight American with diabetes and heart
disease who needs ‘LisinoForminStatin’,” this
book walks us back and helps us see the tra-
jectory that brought us to this current state of
human health. That approach, in turn, should
help us to better align our future best practic-
es, or I certainly hope it does!
The book unfolds in three sections, starting
with “Apes and Humans.” In this section, Li-
eberman unfolds the distinctions of evolution
that led to our being the only mammals who
can run marathon distances in the heat, the
only snoutless primates, and the most accom-
plished animals at projecting handmade weap-
ons with speed and accuracy, among many
other peculiarities. Although integral for de-
veloping the baseline knowledge that leads us
to the next two sections, some people may find
that the level of detail in the first 122 pages
is mildly soporific.
The second section of the book, “Farming
and the Industrial Revolution,” picks up the
pace detailing how the cultural changes ex-
perienced by humans sped up selection of
heritable traits in correlation with booming
populations. Lieberman states, “More than 86%
of the new mutations that have arisen prob-
ably have negative effects.” (p. 205) He goes
on to detail failures in cultural evolution that
still allow health care disparities, skyrocketing
obesity rates, and many other worrisome out-
comes of “dysevolution.” Lieberman poignantly
goes on to state, “So far, the combined efforts
of doctors, parents, public health professionals,
educators, and others to reverse this growing
problem have been mostly ineffectual.” (p. 211)
Moving forward we must understand that “Of
the various mismatch diseases we confront,
some of the most worrying are those caused by
too much of a formerly rare stimulus.” (p. 247)
In the final section, “The Present, the Fu-
ture,” Lieberman takes us through nearly self-
explanatory chapters that outline those rare
stimuli: “The Vicious Cycle of Too Much,” “Dis-
use,” “The Hidden Dangers of Novelty and Dis-
comfort,” and “Survival of the Fitter.” Many
aspects of our current state of health care in
relation to “mismatch” diseases lead to a sense
of hopelessness. Lieberman powerfully depicts
the situation: “ … billions of people suffer from
diseases of affluence, novelty, and disuse that
used to be rare or unknown. We then treat
the symptoms of these diseases because it is
easier, more profitable, and more urgent than
treating their causes, many of which we don’t
understand anyway. In doing so, we perpetuate
a pernicious feedback loop—dysevolution—be-
tween culture and biology.” (p. 366)
Is it possible that such sober reflection on
the titanic collision of our biologic and cultur-
al evolution can shed a powerful and distinct
light on failures of modern health care? I be-
lieve so, and I think this book does a fine job
