Dr. Darwin — Article in Proto, the Mass General Hospital magazine

ANDREW READ RECENTLY SPENT SIX MONTHS on the wards at the University of Michigan Medical Center, observing doctors who treat infectious disease. He recalls one patient, a woman whose bacterial pneumonia resisted treatment by every antibiotic available, and who perished after 18 months. “She died of uncontrolled evolution,” says Read, an evolutionary biologist at Pennsylvania State University who studies antimicrobial resistance. “One of my colleagues said, ‘This was a failure of our science,’ and I agree entirely. We did not know how to slow evolution down.”

“Evolution,” in this case, refers to the refusal of harmful pathogens to sit still and wait to be destroyed by antibiotics or other drugs. They evolve to survive, and Read’s research suggests that resistance to antibiotics occurs because the standard approach to prescribing—administering high doses for long periods in hopes of wiping out every last infectious bug—creates an environment in which resistant strains that somehow do avoid destruction can reproduce freely. Harmful species, now well defended, bounce back to mount ever more potent attacks. That demonstrates the principles of natural selection that Charles Darwin spelled out in On the Origin of Species more than 150 years ago, and Read says that we ignore Darwin’s lessons at our great peril. “We’re picking a fight with natural selection,” says Read. “Going into that fight without Darwin is like going to the moon without Newton.”

Read is part of a growing community of scientists and physicians who believe that medical research and practice have largely ignored evolution, to the detriment of patients.  While  interest in applying Darwin’s ideas to medicine has waxed and waned almost since their introduction, many agree that the contemporary movement to promote the science of evolutionary medicine began with a paper by evolutionary biologist George C. Williams and psychiatrist Randolph M. Nesse, “The Dawn of Darwinian Medicine,” which appeared in The Quarterly Review of Biology in 1991. That article was followed by a popular and influential book by the same authors, Why We Get Sick: The New Science of Darwinian Medicine.

What Williams and Nesse meant by Darwinian or evolutionary medicine was the systematic application of the principles of evolution—competition among organisms, with those best suited for survival living to pass along their genes—to problems in medicine. This approach involves looking both at the human organism as a product of evolution, and at a host of cellular communities in which evolutionary forces are constantly at work.

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