Evolution: medicine's most basic science

Abstract

The celebrations for the bicentennial of Darwin’s birth will be grand for good reason. Darwin’s discoveries are generating new insights faster than ever, especially in medicine and public health. Second editions of important books on evolution and medicine have just appeared, major conferences are taking place worldwide, and scores of universities now off er courses on evolutionary medicine. However, physicians are being left out. Most never take an evolutionary biology course, and no medical school teaches evolutionary biology as a basic medical science. Does this matter? Yes, for two reasons. First, like other basic sciences, evolutionary biology off ers principles that can help solve specifi c medical problems, especially in research. The other reason is more general, but perhaps more important. Evolutionary biology off ers a framework for organising the diverse facts in medicine, and a way to understand why the body is vulnerable to disease. Physicians who can use both the evolutionary and the proximate halves of biology to understand disease will make better decisions, and they can better explain diseases to their patients. Many specifi c evolutionary principles are already widely taught in medicine. For instance, most physicians learn the general principles of population genetics, the foundation for all evolutionary medicine. They may not learn medically important facets, such as why heterozygote advantage, of the sort that causes sickle-cell anaemia, causes relatively few other diseases. They may not learn how selection shaped such