Feature Christmas 2011: Food for Thought

Evolutionary biology within medicine: a perspective of growing value

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7671 (Published 19 December 2011) Cite this as: BMJ 2011;343:d7671
  1. Peter D Gluckman, professor1,
  2. Carl T Bergstrom, professor23
  1. 1Centre for Human Evolution, Adaptation and Disease, and the National Research Centre for Growth and Development, Liggins Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
  2. 2Department of Biology, University of Washington, Seattle, Washington, USA
  3. 3Santa Fe Institute, Santa Fe, New Mexico, USA
  1. Correspondence to: pd.gluckman{at}auckland.ac.nz

Evolutionary biology provides an essential perspective on the determinants of health and disease, believe Peter Gluckman and Carl Bergstrom. It needs to be further integrated into medical research and teaching

In the preface to his 1794 treatise Zoonomia—perhaps the first book in English to present concepts from which modern evolutionary thought eventually arose—Erasmus Darwin, scientist and grandfather of Charles Darwin, wrote that the purpose of such studies is to elucidate the origins of disease. Yet evolutionary biology has had little explicit role in the training of health professionals1 and thus in how medicine is practised and research questions are developed.

Over the past decade, however, the explicit application of evolutionary principles has started to appear within a small but increasing number of medical schools, reflecting a growing recognition of the important perspectives offered on the determinants of health and disease both in individuals and across populations.2 3 4 5 The American Association of Medical Colleges has recently recommended establishing evolutionary biology as a required premedical competency and emphasised the value of evolutionary approaches within the medical curriculum itself.1

Key developments in evolutionary biology and its insights for medicine include the recognition that contemporary evolutionary change is ubiquitous; the accumulation of data on genomic variation within and between human populations; a growing understanding of coevolutionary relationships between host and pathogen; the emergence of major research programmes into symbioses, particularly in relationship to the gastrointestinal microbiome; and an understanding of how evolutionary principles explain the implications of rapidly changing environments for disease susceptibility and human behaviour.4 5 A broader understanding of symptoms of illness such as pain and fever can be developed from an evolutionary perspective and this has clinical implications, such as when to use antipyretics.

How should medical schools and programmes for undergraduate, specialist, …

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