Book Review

Matters of Life and Death: Perspectives on public health, molecular biology, cancer, and the prospects for the human race

N Engl J Med 1997; 337:718September 4, 1997

Article

Matters of Life and Death: Perspectives on public health, molecular biology, cancer, and the prospects for the human race
By John Cairns. 257 pp. Princeton, N.J., Princeton University Press, 1997. $29.95. ISBN: 0-691-02872-9

Human mortality is a subject we are all very much concerned about, but most people are loath to talk, read, or write about it. Until now, the chief causes of death have been natural calamities, nutritional insufficiency, disease, and national conflicts. However, as Cairns points out in the final chapter of this book, in the future the pressures of social factors, economic disparities, and climatic changes — all induced by increasing industrialization and the inherent selfishness of many influential sectors of society — pose a threat far greater than the “natural” disasters of the past.

Until the latter part of this century, there were relatively few accurate and intensive studies of the causes of death in specific populations. The first chapter of this book traces the history of the chief causes of death from prehistoric times to the present day. The chapter ends with a view of mortality in the 21st century, contrasting wealthy and poor nations. Cairns admonishes developed and developing nations alike with respect to the appropriateness of various types of health care systems in relation to their population and economic situations.

Cancer is arguably the most feared disease in developed nations. It is rapidly becoming the leading cause of disease-related mortality in the industrialized world, and the incidence of cancer is increasing dramatically in underdeveloped nations as a result of infectious disease, poor nutrition, and exploitation by developed nations, especially through the sale of tobacco products. Cairns, a well-known molecular biologist and geneticist, presents the history of molecular biology and molecular genetics and then discusses how such knowledge applies to our understanding of the genesis of neoplastic disease, a disease unique to multicellular organisms. Although it is impossible to cover such a complex subject in a single chapter, Cairns's lucid and reasonable approach is quite readable.

As methods for accumulating information on the human population increase, our knowledge of the epidemiology of disease increases almost exponentially. In particular, the epidemiology and statistics of cancer in humans have already led to dramatic breakthroughs in our understanding of the causes of cancer and the potential for preventive measures to control this disease. Cairns points out the dichotomy of such control according to economic factors, especially in developed countries. Epidemiologic information has presented affluent societies in particular with the choice of life or death from cancer, depending on their willingness to adopt specific measures to prevent neoplastic disease.

Cairns concludes his book with a warning that the inventiveness and industriousness of the human race may, if we allow it, lead to a far more rapid destruction of civilization than nuclear war. The history of mortality and knowledge of the molecular mechanisms of living entities form the basis for the survival of the population in the next millennium, if such knowledge is applied in an unselfish and rational manner.

Henry C. Pitot, M.D., Ph.D.
University of Wisconsin, Madison, WI 53706-1599