Evolutionary medicine, sometimes referred to as Darwinian medicine, is an emerging academic field that employs evolutionary principles to aid in the understanding of human health and disease at the levels of both the individual and the population. While its main value lies in giving an ultimate (evolutionary) perspective to patterns of health and disease, there are areas of clinical medicine and public health where it has direct application. Whereas the bulk of clinical medicine is focused on issues of proximate causation and, in particular, pathophysiological mechanisms and their treatment, evolutionary perspectives focus on understanding how and why traits evolved and how they confer greater or lesser disease risk. Evolutionary perspectives also give weight to ecological dimensions, particularly the positioning of individuals within their social and environmental context and also their relationship to other organisms including gut microbiota, parasites, and infectious agents. A core principle of evolutionary medicine is that selection has operated to optimize reproductive fitness, and that this is not the same as selection for health or longevity. Indeed, selection pressures wane with age, and humans have had increasing median lifespans in recent centuries, leading to greater incidence of diseases that occur in the post-reproductive period. Another distinctive feature is an appreciation of the role of cultural evolution and technology in changing the environments within which humans now live—changes that can exaggerate the mismatch between evolved biology and the environment, with health consequences. Selection can occur not only at the level of the whole organism but at the level of a cellular clone, and evolutionary concepts have become important in understanding the progression of cancer. More controversially, evolutionary concepts are contributing to understanding the origin of human behavior at both an individual and a group level, and also to understanding some psychiatric symptomatology. Evolutionary history also contributes to disease risk through anatomical and biochemical vestiges such as the appendix or the lack of the gene to synthesize ascorbic acid (and prevent scurvy); through genetic mechanisms such as founder effects and balancing selection; and through the evolution of defense mechanisms that may operate excessively (e.g., autoimmune disorders), which can explain much common symptomatology (e.g., fever). Being well versed in evolutionary concepts enables medical students and clinicians to integrate factual knowledge of cellular biology, physiology, and anatomy into a meaningful framework, thus promoting a better understanding of human health and disease. This sentiment is being embraced by a growing number of medical schools worldwide as evidenced by the inclusion of evolutionary medicine into the core curricula.
The field of evolutionary medicine owes its genesis to Williams and Nesse 1991 and its authors’ subsequent popular science book Nesse and Williams 1994. From this original somewhat adaptationist focus, evolutionary medicine has matured into a more nuanced and complete field through the publication of multiple books, textbooks, review articles, and special journal issues devoted to the field. The first systematic textbook on evolutionary medicine, Gluckman, et al. 2009, provides comprehensive grounding in basic principles of evolutionary biology of relevance to the medical community and serves as a formal framework through which the impact of evolutionary processes on disease susceptibility can be better understood. Topics covered by edited books such as Stearns and Koella 2008 and Trevathan, et al. 2008 have relatively different emphases and demonstrate well the breadth of the field. The recent concise volume Perlman 2013 offers case studies of specific diseases. All texts are generally suitable for a broad readership including researchers in evolutionary biology, medicine, anthropology, and genetics; physicians; (under)graduate students; and medical educators.
Gluckman, Peter, Alan Beedle, and Mark Hanson. 2009. Principles of evolutionary medicine. Oxford: Oxford Univ. Press.
The first formal textbook to comprehensively explain principles of evolutionary biology from a medical perspective to illustrate its utility in medicine and public health. Drawing on numerous clinical examples, it explicates how the understanding of human health and disease can be informed by adopting an evolutionary perspective. Geared toward medical and health practitioners and students, it is currently used as a course book in anthropology and medical schools.
Nesse, Randolph M., and George C. Williams. 1994. Why we get sick: The new science of Darwinian medicine. New York: Vintage.
Aimed at the educated layperson, this book was the first accessible primer to the field of evolutionary medicine that proposed largely adaptationist evolutionary explanations for why we are vulnerable to disease. Its popularity was a key factor leading to the development of evolutionary medicine as a research domain in its own right.
Perlman, Robert L. 2013. Evolution & medicine. Oxford: Oxford Univ. Press.
A short, nontechnical primer. While more in-depth explanations of fundamental principles of evolutionary biology may be sourced elsewhere (e.g., Gluckman, et al. 2009), this book has its clinical readership in mind by devoting much attention to specific medical problems such as cystic fibrosis, aging, cancer, infectious disease, and malaria, and to how medical insight into these diseases can be aided by the application of evolutionary concepts.
Stearns, Stephen C., and Jacob C. Koella, eds. 2008. Evolution in health and disease. 2nd ed. New York: Oxford Univ. Press.
A well-edited multi-author text. Stearns and Koella open with a useful overview; other chapters provide more specific focus on medical issues with respect to human genetic variation, human behavioral ecology, pathogen evolution, and non-communicable diseases including aging, metabolic disease, and cancer.
Trevathan, Wenda R., E. O. Smith, and James J. McKenna, eds. 2008. Evolutionary medicine and health: New perspectives. New York: Oxford Univ. Press.
A multi-author collection of works of variable relevance that places emphasis on anthropological perspectives and highlights some tensions in the field. Lewis’ penultimate chapter evaluates the research field with a philosophical bent. The tables in the final chapter by Nesse on testing evolutionary hypotheses are an important contribution (see also Nesse 2011, cited under Review Articles).
Williams, George C., and Randolph M. Nesse. 1991. The dawn of Darwinian medicine. Quarterly Review of Biology 66:1–22.
The first paper to formally link the fields of evolution and medicine in a conceptual framework (the term “Darwinian medicine” was first proposed here).
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- Adaptive Radiation
- Ancient DNA
- Behavioral Ecology
- Cognition, Evolution of
- Constraints, Evolutionary
- Convergent Evolution
- Cooperation and Conflict: Microbes to Humans
- Cooperative Breeding in Insects and Vertebrates
- Cryptic Female Choice
- Darwin, Charles
- Disease Virulence, Evolution of
- Epigenetics and Behavior
- Evidence of Evolution, The
- Evolution and Development: Genes and Mutations Underlying ...
- Evolution of New Genes
- Founder Effect Speciation
- Frequency-Dependent Selection
- Fungi, Evolution of
- Gene Duplication
- Gene Expression, Evolution of
- Gene Flow
- Genome Evolution
- Geographic Variation
- History of Evolutionary Thought, 1860-1925
- History of Evolutionary Thought before Darwin
- Human Behavioral Ecology
- Human Evolution
- Hybrid Speciation
- Hybrid Zones
- Inclusive Fitness
- Innovation, Evolutionary
- Kin Selection
- Landscape Genetics
- Landscapes, Adaptive
- Language, Evolution of
- Macroevolutionary Rates
- Male-Male Competition
- Mate Choice
- Medicine, Evolutionary
- Molecular Clocks
- Natural Selection in the Genome, Detecting
- Neutral Theory
- Niche Evolution
- Origin and Early Evolution of Animals
- Origin of Life, The
- Paradox of Sex
- Parental Care, Evolution of
- Personality Differences, Evolution of
- Phylogenetic Trees, Interpretation of
- Polyploid Speciation
- Population Genetics
- Population Structure
- Psychology, Evolutionary
- Punctuated Equilibria
- Quantitative Genetic Variation and Heritability
- Reproductive Proteins, Evolution of
- Selection, Directional
- Selection, Disruptive
- Selection, Natural
- Selection, Sexual
- Sexual Conflict
- Sexual Selection and Speciation
- Speciation Genetics and Genomics
- Speciation, Sympatric
- Species Concepts
- Sperm Competition
- Systems Biology
- Taxonomy and Classification
- Tetrapod Evolution
- Trends, Evolutionary
- Wallace, Alfred Russel