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This article summarizes suggestions from several groups that have considered how evolutionary biology can be useful in medicine, what physicians should learn about it, and when and how they should learn it. It is based on a Sackler Colloquium at the USA National Academy in April 2009.
The paper is open access, a pdf can be downloaded here,
Making evolutionary biology a basic science for medicine
Nesse RM, Bergstrom CT, Ellison PT, Flier JS, Gluckman P, Govindaraju DR, Niethammer D, Omenn GS, Perlman RL, Schwartz MD, Thomas MG, Stearns SC, Valle D.
Proceedings of the National Academy of Sciences.
Published online before print November 16, 2009, doi:10.1073/pnas.0906224106.
New applications of evolutionary biology in medicine are being discovered at an accelerating rate, but few physicians have sufficient educational background to use them fully. This article summarizes suggestions from several groups that have considered how evolutionary biology can be useful in medicine, what physicians should learn about it, and when and how they should learn it. Our general conclusion is that evolutionary biology is a crucial basic science for medicine. In addition to looking at established evolutionary methods and topics, such as population genetics and pathogen evolution, we highlight questions about why natural selection leaves bodies vulnerable to disease. Knowledge about evolution provides physicians with an integrative framework that links otherwise disparate bits of knowledge. It replaces the prevalent view of bodies as machines with a biological view of bodies shaped by evolutionary processes. Like other basic sciences, evolutionary biology needs to be taught both before and during medical school. Most introductory biology courses are insufficient to establish competency in evolutionary biology. Premedical students need evolution courses, possibly ones that emphasize medically relevant aspects. In medical school, evolutionary biology should be taught as one of the basic medical sciences. This will require a course that reviews basic principles and specific medical applications, followed by an integrated presentation of evolutionary aspects that apply to each disease and organ system. Evolutionary biology is not just another topic vying for inclusion in the curriculum; it is an essential foundation for a biological understanding of health and disease.
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)
Principles of evolutionary medicine
by Peter Gluckman, Alan Beedle and Mark Hanson
The evolutionary medicine community has long emphasized the need to teach evolution in relation to medicine to medical students. In their efforts to bring evolution into medical schools, advocates of evolutionary medicine encountered various obstacles. These ranged from the unwillingness of school deans to commit ‘precious’ curriculum time to a new, uninstitutionalized subject, to a general lack of appreciation, within the medical community , of contribution that the knowledge of evolution may make to medicine. One obstacle that received less attention was the lack of an appropriate textbook. The field of evolutionary medicine by no means lacks good book-length studies-starting with Randolph Nesse’s and George C. William’s now classic Why we get sick or the more recent Evolution in health and disease, edited by Stephen C. Stearns and Jacob C. Koella-but none was written with medical students, who will know something about human disease but in most cases very little about evolution, as target audience in mind.
This gap should be filled by the new textbook by Peter Gluckman, Alan Beedle and Mark Hanson, Principles of evolutionary medicine, published this month by the Oxford University Press. The aim of the book is to cover the basics of evolutionary biology and then explain how human disease could be understood from an evolutionary viewpoint. The book is divided as follows:
Part 1. Fundamentals of evolutionary biology
Chapter 1. Introduction
Chapter 2. Evolutionary theory
Chapter 3. The molecular basis of variation and inheritance
Chapter 4. Evolution and development
Chapter 5. Evolution of life histories
Chapter 6. Human evolution and the origins of human diversity
Part 2. Understanding human disease from an evolutionary perspective
Chapter 7. Reproduction
Chapter 8. Nutrition and metabolic adaptation
Chapter 9. Defence
Chapter 10. Social organization and behaviour
Part 3. An evolutionary framework for health and disease
Chapter 11. Evolutionary principles applied to medical practice
Coda. Evolutionary medicine and society
A more detailed description of the content is available on the book website: http://evomedicine.org/.
It is hoped that the book will be taken up by those teaching evolutionary medicine, and that it will provide a helpful argument to those who are trying to persuade medical schools to introduce a new course.