Book excerpt: The Deadly Truth chronicles the complex interactions between disease and the peoples of America from the pre-Columbian world to the present. Grob's ultimate lesson is stark but valuable: there can be no final victory over disease. The world in which we live undergoes constant change, which in turn creates novel risks to human health and life. We conquer particular diseases, but others always arise in their stead. In a powerful challenge to our tendency to see disease as unnatural and its virtual elimination as a real possibility, Grob asserts the undeniable biological persistence of disease. Diseases ranging from malaria to cancer have shaped the social landscape--sometimes through brief, furious outbreaks, and at other times through gradual occurrence, control, and recurrence. Grob integrates statistical data with particular peoples and places while giving us the larger patterns of the ebb and flow of disease over centuries. Throughout, we see how much of our history, culture, and nation-building was determined--in ways we often don't realize--by the environment and the diseases it fostered. The way in which we live has shaped, and will continue to shape, the diseases from which we get sick and die. By accepting the presence of disease and understanding the way in which it has physically interacted with people and places in past eras, Grob illuminates the extraordinarily complex forces that shape our morbidity and mortality patterns and provides a realistic appreciation of the individual, social, environmental, and biological determinants of human health.