Making Evolutionary Biology a Basic Science for Medicine

Department of Psychiatry and Psychology, University of Michigan, Room 3018, East Hall, 530 Church Street, Ann Arbor, MI 48104, USA.
Proceedings of the National Academy of Sciences (Impact Factor: 9.67). 11/2009; 107 Suppl 1(suppl_1):1800-7. DOI: 10.1073/pnas.0906224106
Source: PubMed


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.

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Available from: Randolph M Nesse
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    • "Apparently 'simple' interventions are frequently complex and unpredictable in their effects (Read et al. 2011; Derde et al. 2014; McVicker et al. 2014; Nicolle 2014). This realization argues for the set-up of more fundamental research programmes as well as a broader education during training to create awareness among young trainees (Nesse et al. 2010; Ashbolt et al. 2013; Viana et al. 2014). Complex interventions are also those that associate different interventions influencing various factors involved in a complex problem, as AbR. "
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    • "As the interface between evolutionary biology and genomic medicine progresses into the mainstream of clinical research and training, it is becoming important to establish conceptual frameworks for exploring this interface based on sound null hypotheses . Such frameworks are a prerequisite for the scientific evaluation of claims concerning the role or utility of evolutionary biology in medicine (Miller and Kumar 2001; Gluckman et al. 2009; Nesse et al. 2009; Kumar et al. 2011). Here we suggest, with strong support from the empirical data, that the classical neutral theory of molecular evolution (NTME) (Kimura 1983) provides a ready, validated framework for generating a null hypothesis required for the discovery, characterization, and clinical evaluation of human disease-associated variation. "
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    ABSTRACT: Many perspectives on the role of evolution in human health include nonempirical assumptions concerning the adaptive evolutionary origins of human diseases. Evolutionary analyses of the increasing wealth of clinical and population genomic data have begun to challenge these presumptions. In order to systematically evaluate such claims, the time has come to build a common framework for an empirical and intellectual unification of evolution and modern medicine. We review the emerging evidence and provide a supporting conceptual framework that establishes the classical neutral theory of molecular evolution (NTME) as the basis for evaluating disease- associated genomic variations in health and medicine. For over a decade, the NTME has already explained the origins and distribution of variants implicated in diseases and has illuminated the power of evolutionary thinking in genomic medicine. We suggest that a majority of disease variants in modern populations will have neutral evolutionary origins (previously neutral), with a relatively smaller fraction exhibiting adaptive evolutionary origins (previously adaptive). This pattern is expected to hold true for common as well as rare disease variants. Ultimately, a neutral evolutionary perspective will provide medicine with an informative and actionable framework that enables objective clinical assessment beyond convenient tendencies to invoke past adaptive events in human history as a root cause of human disease.
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    • "One reason for this oversight has been the inability of medical practitioners to realize the importance of evolutionary principles in human disease. Recent advances in molecular biology such as the Human Genome Project have broadened medical understanding of the human body and its genetic vulnerabilities.21 A second reason for this lapse has been medical practitioners tendency to focus on proximal causes of disease.22 "
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