The importance of evolution in medicine

By Hilary Miller 14/01/2010

An upcoming issue of PNAS has a special supplement on evolutionary medicine, with articles arising from the Arthur Sackler Colloquium on “Evolution in Health and Medicine” that was held last year. 

Evolutionary medicine is a relatively newly recognised field that applies the principles of evolutionary biology to understanding health and disease.  But medical science has in fact been making use of evolutionary biology for a long time – our understanding of things like viral transmission between species, antibiotic resistance, and geographic differences in disease susceptibility are all fundamentally based on evolutionary principles.  The applications of evolutionary biology to medicine are increasing, as shown by the diverse topics covered in the colloquium.

An article by co-authored by several leading researchers in evolutionary medicine, including Randolph Nesse, Carl Bergstrom and our own Peter Gluckman is particularly interesting –  making the case that evolutionary biology is a crucial basic science for medicine that should be taught to all medical students.  Nesse and colleagues point out that, not only are there direct applications of evolution to medicine, but that the principles of evolution apply to every biological system and level, providing a ”unifying framework for interpreting biological phenomena”.  

Given how fundamentally important evolutionary principles are to understanding much of biology, it is somewhat shocking to think that the majority of medical students around the world are not taught any evolutionary biology – as Nesse says “It is as if engineering students never learned physics”.  Medical training (or pre-med training in countries where an undergrad degree is required to get into medical school) covers many basic sciences that don’t necessarily have a direct application to medicine, but are important for understanding the body and disease – including mathematics, chemistry, physics, biochemistry, cell biology, physiology etc.  Evolutionary biology is as essential for understanding the body and disease as cell biology or physiology – providing the “how” and ”why” explanations (e.g. how the human body has developed the way it did, why we are susceptible to disease), rather than just mechanistic explanations that look on the human body as a machine. 

The situation in New Zealand is currently not much different to overseas.  Here medical training takes 6 years, with no requirement for an undergraduate degree first.  The first year of medical training is same as a basic degree in Health Sciences, covering basic biology, chemistry, physics, cell biology, physiology, population health/epidemiology.  Second and third year courses are largely organ-based courses, with some general medicine training, and medical genetics is taught in year 3 (at least in Auckland, I’m not sure about Otago).  But no evolutionary biology, except what may be given a cursory look in basic biology.  I wouldn’t be surprised if we see a change in New Zealand before too long however, as the PM’s chief science advisor Peter Gluckman has been an advocate for teaching evolution to medical students.  In addition to being a co-author on the paper I mentioned above, he has recently co-authored a text-book on Evolutionary Medicine.

The papers from the colloquium are currently available online at PNAS (to come out in an upcoming issue) – unfortunately these are behind a pay-wall, but you can view the talks from the Colloquium that these papers are based on for free here.

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