Darwinian Medicine at 20–Article in Science

Darwinian Medicine’s Drawn-Out Dawn  By  Elizabeth Pennisi

Science 16 December 2011: Vol. 334 no. 6062 pp. 1486-1487    DOI: 10.1126/science.334.6062.1486

Ever since Darwin, physicians have wondered why humans haven’t evolved to be healthier. Blame natural selection itself, says Randolph Nesse, a psychiatrist at the University of Michigan, Ann Arbor.  Twenty years ago, Nesse and evolutionary biologist George Williams attributed our vulnerability to disease to our evolutionary history. The most widely propagated versions of genes are those that made more babies possible, irrespective of their effect on health and well-being, they noted. Evolution, in other words, didn’t always favor prolonged good health. Viewed through an evolutionary lens, disease symptoms such as fever and diarrhea were likely imperfect weapons in the body’s defenses against infection, they argued. They also pointed out that our immune systems could not evolve fast enough to keep ahead of germs, and that other mismatches have developed between our bodies and modern environments.

In their 1991 paper in The Quarterly Review of Biology, Williams and Nesse urged medicine to embrace evolutionary thinking. Aptly titled “The Dawn of Darwinian Medicine,” it called the dearth of evolutionary biology in medical schools “unfortunate” and asked physicians to be “as attuned to Darwin as they have been to Pasteur,” as that would be the only way to truly understand why we get sick and could lead to changes in medical practice.

Twenty years later, there are signs that Williams and Nesse’s ideas are getting traction. About 30 courses on evolutionary medicine, as the field is known, are being taught in universities; two journals are in the works; the U.S. National Institutes of Health (NIH) is about to unveil new high school curricula incorporating evolutionary medicine; and more parts of the medical community are recognizing its potential for providing a holistic framework for their increasingly specialized field. But it has been a long slog to get to this point, and proponents say there is still a long way to go.
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