Nothing in medicine makes sense, except in the light of evolution

Abstract

The practice of medicine is a fruitful marriage of classic diagnostic and healing arts with modern advancements in many relevant sciences. The scientific aspects of medicine are rooted in understanding the biology of our species and those of other organisms that interact with us in health and disease. Thus, it is reasonable to paraphrase Dobzhansky, stating that, "nothing in the biological aspects of medicine makes sense except in the light of evolution." However, the art and science of medicine are also rooted in the unusual cognitive abilities of humans and the cultural evolutionary processes arising. This explains the rather bold and inclusive title of this essay. The near complete absence of evolution in medical school curricula is a historical anomaly that needs correction. Otherwise, we will continue to train generations of physicians who lack understanding of some fundamental principles that should guide both medical practice and research. I here recount my attempts to correct this deficiency at my own medical school and the lessons learned. I also attempt to summarize what I teach in the limited amount of time allowed for the purpose. Particular attention is given to the value of comparing human physiology and disease with those of other closely related species. There is a long way to go before the teaching of evolution can be placed in its rightful context within the medical curriculum. However, the trend is in the right direction. Let us aim for a day when an essay like this will no longer be relevant.

Evolutionary medicine: its scope, interest and potential

“…The modern version of the evolutionary medicine project, started by Williams & Nesse [1,2], has been surveyed in recent books by Trevathan et al [3], Stearns & Koella [4] and Gluckman et al [5]; in several review papers [6][7][8][9][10]; and in special issues of Evolutionary Applications [11], the Proceedings of the National Academy of Science [9] and The Journal of Molecular Medicine [12]. If this paper has any added value, it comes from the perspectives gained from having taught several courses and having addressed a wide range of audiences.…”

Medicina Evolutiva: Incorporando a Teoria da Evolução na Formação de Profissionais de Saúde Brasileiros

“…Isso poderia contribuir para o aprendizado de conceitos de evolução com base no estudo de temas de interesse direto de estudantes de Medicina 47 . Educadores da área médica chegam a parafrasear Dobzhansky 48 (p.…”

“…125), talvez com excessivo entusiasmo, e a afirmar que, assim como na Biologia, "nada na medicina faz sentido senão à luz da evolução" 47 .…”

The evolution of evolutionary molecular medicine

“…In a further important step, an "evolutionary" approach to medicine studies the relationship between genomic data from humans with the ones of hominids and primates, in relation to the differences in symptoms of diseases across these different species [3][4][5]. Direct medical applications of identifying sequence variations associated with specific diseases receive the most attention; however, new sequencing technologies are also transforming evolutionary biology in ways that will make it far more important for medicine.…”