Book Review: “Evil Air: A Story of Medicine”

Igor Rudan: Evil Air: A Story of Medicine. Edinburgh: Inishmore, 2022; pp. 1–226. ISBN 978-1-9999564-6-2

In his popular science book “Evil Air”, which has been a best-seller in his home country Croatia and which was then translated to several other languages already, Igor Rudan offers an ambitious, genre-spanning exploration of medicine that seeks to situate human health within the widest possible intellectual frame: from the origins of life and consciousness to the geopolitics of global health. Subtitled “A Story of Medicine”, the book is less a conventional historical account than an integrative narrative that blends evolutionary biology, epidemiology, neuroscience, infectious disease, public health, and futurism. It is written with the explicit intention of making medicine intelligible not only to clinicians and scientists, but also to general readers seeking a deeper understanding of humanity’s biological condition and its entanglement with environment, technology, and inequality.

The book has been built on remarkable, exciting stories behind all Nobel Prizes that were awarded for physiology or medicine to date. At its core, the book advances a simple but powerful thesis: that human health cannot be understood in isolation from the ecological, evolutionary, and societal systems in which it is embedded. Rudan’s storytelling moves fluently across scales - from molecular, to organismal and planetary - arguing that medicine’s greatest achievements have arisen when it has successfully connected these levels. The work is therefore both synthetic and didactic, aspiring to function as a conceptual bridge between biomedical science and global public health.

The opening chapters establish the philosophical and biological foundations of the narrative. Rudan begins with life itself, asking what it means to be alive. He frames human existence as a temporary organization of atoms, sustained by energy flows that resist entropy. This thermodynamic framing is not merely rhetorical; it sets up a recurring motif in the book: that life is a precarious state maintained against constant physical and biological threats. From this point disease emerges as an expected by-product of complex living systems, rather than an aberration.

Rudan’s treatment of cellular biology is notable for its clarity and pedagogical intent. He revisits Nobel-Prize-winning discoveries, from the regulation of the cell cycle to apoptosis and telomere biology, to illustrate how life is governed by tightly controlled processes of growth, repair, and programmed death. These discussions are less about molecular detail, and more about some key conceptual insights: that longevity, cancer, and ageing are all consequences of the same cellular machinery that makes life possible. By foregrounding these mechanisms early, the author prepares readers to understand disease as dysregulation within, as well as externally induced suboptimality in internal organisation.

From cellular life, the narrative ascends to the emergence of consciousness. Rudan treats the brain as medicine’s final frontier. At this point in time, it is an organ whose material structure is well mapped, yet whose emergent properties remain elusive, which is unlike other structures in the human body where we can understand the function from the structure. His synthesis of neuroscience history, from Golgi and Ramón y Cajal to modern neurotransmitter research, serves to illustrate how incremental discoveries have illuminated neural signalling while leaving the nature of subjective awareness unresolved. Particularly compelling is his engagement with artificial intelligence: he frames machine cognition as a philosophical challenge to biology’s monopoly on consciousness, which is something well beyond technological novelty. This move situates medicine within broader debates about the future of intelligence and personhood.

The sensory sciences receive similarly expansive treatment. Rudan describes human perception as an evolutionary compromise, which is finely tuned for survival within a narrow ecological niche rather than for objective apprehension of reality. The exposition of vision, hearing, smell, and spatial orientation is interwoven with Nobel histories, reinforcing the cumulative nature of biomedical progress. Yet the deeper argument is epistemological: our understanding of disease and environment is constrained by the limits of human perception, requiring technological extension through microscopes, imaging, and molecular tools.

One of the book’s most distinctive sections examines sleep and dreams. Here, Rudan blends established physiology with speculative reflection, exploring circadian rhythms, REM cycles, hormonal regulation, and the restorative functions of sleep. He juxtaposes laboratory science with “citizen science” discussions drawn from public engagement, illustrating how lay hypotheses, however fanciful, can stimulate scientific curiosity. While some readers may find these excursions philosophically indulgent, they underscore the author’s commitment to portraying medicine as an open, participatory enterprise rather than a closed technocracy.

Having established biological fundamentals, Rudan turns decisively toward disease. Firstly, he addresses infectious disease, which forms the historical backbone of the book. Chapters on epidemics, parasites, and environmental pathogens trace humanity’s long struggle with invisible adversaries. The titular concept of “evil air” evokes miasmatic theories of disease, but applies to malaria and five Nobel prizes that were awarded for fighting that disease. “Evil air” can also be seen as relevant to examining modern air pollution and respiratory risk. In doing so, Rudan draws a deliberate parallel between pre-germ-theory misunderstandings and contemporary failures to confront environmental determinants of health.

His case studies are geographically and biologically diverse. River blindness, kuru (“the laughing death”), cholera, and yellow fever are recounted not merely as clinical entities but as socio-ecological events shaped by poverty, colonialism, and infrastructure deficits. Rudan excels in conveying how scientific breakthroughs such as vector control, antimicrobial therapy, or vaccination had all been translated into population-level survival gains. The narrative repeatedly returns to a central epidemiological insight: that the greatest advances in human longevity have arisen from public health interventions, rather than curative medicine alone.

This population perspective culminates in one of the book’s strongest thematic arcs: the moral and political economy of global health. Rudan interrogates why preventable diseases persist in low-income settings despite existing solutions. He attributes this to structural inequities in wealth, governance, and international prioritisation. The discussion of the “bottom billion” situates disease burden within development economics, echoing the work of scholars who argue that health disparities both reflect and reinforce global inequality.

Importantly, Rudan avoids fatalism. He highlights successful eradication and control campaigns, demonstrating that coordinated international action can overcome even entrenched diseases. The eradication of smallpox, near-elimination of river blindness in some regions, and advances in vaccine delivery are presented as proof-of-concept for future global cooperation. This optimism is tempered, however, by warnings about emerging threats, such as antimicrobial resistance, climate change, urbanisation, and ecological disruption.

The later chapters pivot toward frontier biomedicine. Synthetic biology, cellular engineering, and de-extinction science are discussed as harbingers of a new medical epoch in which humans may not only treat disease but also redesign life itself. Rudan approaches these developments with cautious fascination. He acknowledges their therapeutic promise while probing their ethical and ecological implications. The possibility of extending lifespan, resurrecting extinct organisms, or constructing artificial cells is framed less as science fiction, and more as an imminent policy challenge.

Throughout the book, Rudan employs a narrative strategy that alternates between macro-history and micro-mechanism. A discussion of parasites may venture into immunology, while an analysis of historical epidemic may briefly skip to molecular virology. This oscillation mirrors the intellectual structure of modern medicine itself, which is simultaneously reductionist and systemic. For scientifically literate readers, the effect is intellectually highly satisfying.

Stylistically, the prose is accessible without being simplistic. Rudan writes with the cadence of a public intellectual rather than a laboratory scientist. He uses many metaphors in a very original and skilled way. Life can be thought of as orchestration, the brain as an integrator, disease as an invisible war that is being waged within the body. His excellent metaphors are deployed to translate complexity into narrative form. This rhetorical accessibility positions the book within the tradition of popular science, yet its evidentiary grounding and bibliographic apparatus anchor it firmly in scholarly discourse.

A notable strength is the integration of Nobel Prize histories as narrative scaffolding. By tracing discoveries through their laureates, Rudan personalises scientific progress while reinforcing the cumulative, collaborative nature of biomedical knowledge. This approach also serves an educational function, introducing readers to landmark experiments without resorting to technical abstraction.

The danger of writing the book of such panoramic scope is to occasionally generate thematic diffusion, but Rudan seems to navigate this challenge well enough. Some speculative passages, particularly those concerning dreams, parallel realities, or existential interpretations of sleep, may also appear epistemologically distant from the empiricism that defines modern medicine in other chapters, but these reflections do enrich the philosophical texture of the book in an interesting trade-off. Additionally, the book’s global health sections, though compelling, sometimes prioritise moral argument over policy specificity, while also avoiding detailed evaluation of financing mechanisms, health-system design, or implementation science. Yet this critique must be balanced against the book’s intended function, which is a synthesis rather than technical manual, and its popular science appeal.

Where the work succeeds most powerfully is in its insistence that medicine is inseparable from environment. Air pollution, water quality, vector ecology, and climate systems recur as determinants as consequential as microbes or genes. In reframing “evil air” as both historical metaphor and contemporary hazard, Rudan underscores the unfinished agenda of environmental and planetary health, i.e., the fields that remain under-prioritised despite mounting epidemiological evidence.

The closing chapters address governance by asking who truly “rules” global health. Here, Rudan surveys the interplay of multilateral agencies, philanthropic foundations, national governments, and private industry. He suggests that progress depends less on scientific discovery than on political alignment and resource allocation. This systems view is expected to resonate strongly in the post-pandemic era, where vaccine equity and preparedness financing exposed structural vulnerabilities in global coordination.

In evaluating “Evil Air” within the canon of medical literature, comparisons arise with works by Siddhartha Mukherjee, Hans Rosling, and Laurie Garrett, the authors who similarly blend narrative storytelling with epidemiological insight. Rudan’s distinctive contribution lies in his insistence on conceptual continuity: that cell biology, neuroscience, infectious disease, and global policy are chapters of a single story, rather than separate disciplines. For readers of the Journal of Global Health Economics and Policy, the book offers new value primarily as an integrative intellectual map. It reminds specialists of the wider contexts in which their discoveries operate. In an era of hyper-specialisation, such synthesis is itself a scholarly service.

Ultimately, “Evil Air” is an argument for humility as much as for progress. It portrays medicine as a triumph of collective inquiry, yet one perpetually confronted by new uncertainties, such as emergent pathogens, technological disruption, planetary change, and many others. Rudan’s narrative suggests that the future of health will depend both on conquering nature and on learning to coexist sustainably within it. If the book has a unifying message, it is that survival has always depended on knowledge translated into action. The story of medicine, in Rudan’s telling, is therefore not only scientific but civilisational. It is a chronicle of how humanity learned, gradually and unevenly, but nevertheless persistently, to protect itself and extend its lifespan and quality of life over a long period of time. It also seems optimistic that further advances in that line of progress can be expected.

Disclosure of Interest

DA is co-Editor-in-Chief of the Journal of Global Health Economics and Policy. This role did not influence the preparation, review, or decision regarding this book review.