Science 4 September 2009:
Medicine: Evolutionary Biology for Doctors
The reviewer is at the Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA.
In his 1870 address to medical students at University College, London, Thomas Huxley—already known as “Darwin’s bulldog” and fast becoming the most important voice in Britain on all policy questions regarding science and education—did not mention evolution even once. In fact, far from suggesting the inclusion of evolution in medical curricula, he advocated removing unnecessary topics, including his own beloved field of comparative anatomy. There was simply too much information medical students needed to absorb from the crucial areas of physiology, pathology, and pharmacology for broad topics such as evolutionary biology to be covered.
In 2009, the 150th anniversary of the publication of On the Origin of Species, evolutionary biology is still trying to earn a place in medical education. The core competencies recommended by a recent joint committee of the Association of American Medical Colleges and the Howard Hughes Medical Institute on the scientific knowledge required by future physicians include an understanding of evolution by natural selection (1). At an April meeting, “Evolution in Health and Medicine,” sponsored by the National Academy of Sciences and the Institute of Medicine, a panel of deans and faculty from leading medical schools around the world endorsed the incorporation of evolutionary principles in medical curricula (2). And yet one can probably count on the digits of a three-toed sloth the number of medical schools currently offering such instruction.
Part of the problem is still the crowded medical curriculum that Huxley recognized. But in the era of genomics and proteonomics, this no longer seems an adequate excuse. More problematic may be the lack of appropriately skilled faculty members to teach evolutionary principles and the lack of appropriate materials from which to teach. In the 14 years since Randolph Nesse and George Williams published Why We Get Sick (3), a number of books devoted to Darwinian medicine have appeared. But they have either been edited compendia of recent research that assume an understanding of evolution or popular reads for a lay public. Principles of Evolutionary Medicine, by Peter Gluckman, Alan Beedle, and Mark Hanson (authorities on the developmental origins of health and disease), is the first specifically designed as a textbook appropriate for medical students and medical schools, and it succeeds brilliantly.
For the rest of this review, see http://www.sciencemag.org/cgi/content/short/325/5945/1207 (paid content)