Medicine:Evolutionary medicine

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Short description: Application of modern evolutionary theory to understanding health and disease
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Evolutionary medicine or Darwinian medicine is the application of modern evolutionary theory to understanding health and disease. Modern biomedical research and practice have focused on the molecular and physiological mechanisms underlying health and disease, while evolutionary medicine focuses on the question of why evolution has shaped these mechanisms in ways that may leave us susceptible to disease. The evolutionary approach has driven important advances in the understanding of cancer,[1] autoimmune disease,[2] and anatomy.[3] Medical schools have been slower to integrate evolutionary approaches because of limitations on what can be added to existing medical curricula.[4] The International Society for Evolution, Medicine and Public Health coordinates efforts to develop the field. It owns the Oxford University Press journal Evolution, Medicine and Public Health and The Evolution and Medicine Review.

Core principles

Utilizing the Delphi method, 56 experts from a variety of disciplines, including anthropology, medicine, nursing, and biology agreed upon 14 core principles intrinsic to the education and practice of evolutionary medicine.[5] These 14 principles can be further grouped into five general categories: question framing, evolution I and II (with II involving a higher level of complexity), evolutionary trade-offs, reasons for vulnerability, and culture. Additional information regarding these principles may be found in the table below.

Core Principles of Evolutionary Medicine[5]
Topic Core Principle
Types of explanation (question framing) Both proximate (mechanistic) and ultimate (evolutionary) explanations are needed to provide a full biological understanding of traits, including those that increase vulnerability to disease.
Evolutionary processes (evolution I) All evolutionary processes, including natural selection, genetic drift, mutation, migration and non-random mating, are important for understanding traits and disease.
Reproductive success (evolution I) Natural selection maximizes reproductive success, sometimes at the expense of health and longevity.
Sexual selection (evolution I) Sexual selection shapes traits that result in different health risks between sexes.
Constraints (evolution I) Several constraints inhibit the capacity of natural selection to shape traits that are hypothetically optimal for health.
Trade-offs (evolutionary trade-offs) Evolutionary changes in one trait that improve fitness can be linked to changes in other traits that decrease fitness.
Life History Theory (evolutionary trade-offs) Life history traits, such as age at first reproduction, reproductive lifespan and rate of senescence, are shaped by evolution, and have implications for health and disease.
Levels of selection (evolution II) Vulnerabilities to disease can result when selection has opposing effects at different levels (e.g. genetic elements, cells, organisms, kin and other levels).
Phylogeny (evolution II) Tracing phylogenetic relationships for species, populations, traits or pathogens can provide insights into health and disease.
Coevolution (evolution II) Coevolution among species can influence health and disease (e.g. evolutionary arms races and mutualistic relationships such as those seen in the microbiome).
Plasticity (evolution II) Environmental factors can shift developmental trajectories in ways that influence health and the plasticity of these trajectories can be the product of evolved adaptive mechanisms.
Defenses (reasons for vulnerability) Many signs and symptoms of disease (e.g. fever) are useful defenses, which can be pathological if dysregulated.
Mismatch (reasons for vulnerability) Disease risks can be altered for organisms living in environments that differ from those in which their ancestors evolved.
Cultural practices (culture) Cultural practices can influence the evolution of humans and other species (including pathogens), in ways that can affect health and disease (e.g. anti-biotic use, birth practices, diet, etc.).

Human adaptations

Adaptation works within constraints, makes compromises and trade-offs, and occurs in the context of different forms of competition.[6]

Constraints

Adaptations can only occur if they are evolvable. Some adaptations which would prevent ill health are therefore not possible.

  • DNA cannot be totally prevented from undergoing somatic replication corruption; this has meant that cancer, which is caused by somatic mutations, has not (so far) been eliminated by natural selection.
  • Humans cannot biosynthesize vitamin C, and so risk scurvy, vitamin C deficiency disease, if dietary intake of the vitamin is insufficient.
  • Retinal neurons and their axon output have evolved to be inside the layer of retinal pigment cells. This creates a constraint on the evolution of the visual system such that the optic nerve is forced to exit the retina through a point called the optic disc. This, in turn, creates a blind spot. More importantly, it makes vision vulnerable to increased pressure within the eye (glaucoma) since this cups and damages the optic nerve at this point, resulting in impaired vision.

Other constraints occur as the byproduct of adaptive innovations.

Trade-offs and conflicts

One constraint upon selection is that different adaptations can conflict, which requires a compromise between them to ensure an optimal cost-benefit tradeoff.

Competition effects

Different forms of competition exist and these can shape the processes of genetic change.

Lifestyle

Humans evolved to live as simple hunter-gatherers in small tribal bands, while contemporary humans have a more complex life.[13][14] This change may make present-day humans susceptible to lifestyle diseases.

Diet

In contrast to the diet of early hunter-gatherers, the modern Western diet often contains high quantities of fat, salt, and simple carbohydrates, such as refined sugars and flours.[15][16][17]

Among different countries, the incidence of colon cancer varies widely, and the extent of exposure to a Western pattern diet may be a factor in cancer incidence.[18]

Life expectancy

Main page: Biology:Aging-associated diseases

Examples of aging-associated diseases are atherosclerosis and cardiovascular disease, cancer, arthritis, cataracts, osteoporosis, type 2 diabetes, hypertension and Alzheimer's disease. The incidence of all of these diseases increases rapidly with aging (increases exponentially with age, in the case of cancer).

Age-Specific SEER Incidence Rates, 2003-2007

Of the roughly 150,000 people who die each day across the globe, about two thirds—100,000 per day—die of age-related causes.[19] In industrialized nations, the proportion is much higher, reaching 90%.[19]

Exercise

Many contemporary humans engage in little physical exercise compared to the physically active lifestyles of ancestral hunter-gatherers.[20][21][22][23][24] Prolonged periods of inactivity may have only occurred in early humans following illness or injury, so a modern sedentary lifestyle may continuously cue the body to trigger life preserving metabolic and stress-related responses such as inflammation, and some theorize that this causes chronic diseases.[25]

Cleanliness

Contemporary humans in developed countries are mostly free of parasites, particularly intestinal ones. This is largely due to frequent washing of clothing and the body, and improved sanitation. Although such hygiene can be very important when it comes to maintaining good health, it can be problematic for the proper development of the immune system. The hygiene hypothesis is that humans evolved to be dependent on certain microorganisms that help establish the immune system, and modern hygiene practices can prevent necessary exposure to these microorganisms. "Microorganisms and macroorganisms such as helminths from mud, animals, and feces play a critical role in driving immunoregulation" (Rook, 2012[26]). Essential microorganisms play a crucial role in building and training immune functions that fight off and repel some diseases, and protect against excessive inflammation, which has been implicated in several diseases. For instance, recent studies have found evidence supporting inflammation as a contributing factor in Alzheimer's Disease.[27]

Specific explanations

This is a partial list: all links here go to a section describing or debating its evolutionary origin.

Life stage related


Other


Evolutionary psychology

As noted in the table below, adaptationist hypotheses regarding the etiology of psychological disorders are often based on analogies with evolutionary perspectives on medicine and physiological dysfunctions (see in particular, Randy Nesse and George C. Williams' book Why We Get Sick).[43] Evolutionary psychiatrists and psychologists suggest that some mental disorders likely have multiple causes.[63]

Possible Causes of Psychological 'Abnormalities' from an Adaptationist Perspective

Summary based on information in Buss (2011),[64] Gaulin & McBurney (2004),[65] Workman & Reader (2004)[66]

Possible cause Physiological Dysfunction Psychological Dysfunction
Functioning adaptation
(adaptive defense)		 Fever / Vomiting
(functional responses to infection or ingestion of toxins)		 Mild depression or anxiety
(functional responses to mild loss or stress)
By-product of an adaptation(s) Intestinal gas
(byproduct of digestion of fiber)		 Sexual fetishes (?)
(possible byproduct of normal sexual arousal adaptations that have 'imprinted' on unusual objects or situations)
Adaptations with multiple effects Gene for malaria resistance, in homozygous form, causes sickle cell anemia Adaptation(s) for high levels of creativity may also predispose schizophrenia or bi-polar disorder
(adaptations with both positive and negative effects, perhaps dependent on alternate developmental trajectories)
Malfunctioning adaptation Allergies
(over-reactive immunological responses)		 Autism
(possible malfunctioning of theory of mind module)
Frequency-dependent morphs The two sexes / Different blood and immune system types Personality traits and personality disorders
(may represent alternative behavioral strategies dependent on the frequency of the strategy in the population)
Mismatch between ancestral & current environments Modern diet-related Type 2 Diabetes More frequent modern interaction with strangers (compared to family and close friends) may predispose greater incidence of depression & anxiety
Tails of normal (bell shaped) curve Very short or tall height Tails of the distribution of personality traits (e.g., extremely introverted or extroverted)

See several topic areas, and the associated references, below.



History

Charles Darwin

Charles Darwin did not discuss the implications of his work for medicine, though biologists quickly appreciated the germ theory of disease and its implications for understanding the evolution of pathogens, as well as an organism's need to defend against them.

Medicine, in turn, ignored evolution, and instead focused (as done in the hard sciences) upon proximate mechanical causes.

medicine has modelled itself after a mechanical physics, deriving from Galileo, Newton, and Descartes.... As a result of assuming this model, medicine is mechanistic, materialistic, reductionistic, linear-causal, and deterministic (capable of precise predictions) in its concepts. It seeks explanations for diseases, or their symptoms, signs, and cause in single, materialistic— i.e., anatomical or structural (e.g., in genes and their products)— changes within the body, wrought directly (linearly), for example, by infectious, toxic, or traumatic agents.[74] p. 510

George C. Williams was the first to apply evolutionary theory to health in the context of senescence.[32] Also in the 1950s, John Bowlby approached the problem of disturbed child development from an evolutionary perspective upon attachment.

An important theoretical development was Nikolaas Tinbergen's distinction made originally in ethology between evolutionary and proximate mechanisms.[75]

Randolph M. Nesse summarizes its relevance to medicine:

all biological traits need two kinds of explanation, both proximate and evolutionary. The proximate explanation for a disease describes what is wrong in the bodily mechanism of individuals affected by it. An evolutionary explanation is completely different. Instead of explaining why people are different, it explains why we are all the same in ways that leave us vulnerable to disease. Why do we all have wisdom teeth, an appendix, and cells that can divide out of control?[76]

The paper of Paul Ewald in 1980, "Evolutionary Biology and the Treatment of Signs and Symptoms of Infectious Disease",[77] and that of Williams and Nesse in 1991, "The Dawn of Darwinian Medicine"[78] were key developments. The latter paper "draw a favorable reception",[43]page x and led to a book, Why We Get Sick (published as Evolution and healing in the UK). In 2008, an online journal started: Evolution and Medicine Review.

In 2000, Paul Sherman hypothesised that morning sickness could be an adaptation that protects the developing fetus from foodborne illnesses, some of which can cause miscarriage or birth defects, such as listeriosis and toxoplasmosis.[79]

See also

References

  1. ↑ "Cancer as an evolutionary and ecological process". Nature Reviews. Cancer 6 (12): 924–35. December 2006. doi:10.1038/nrc2013. PMID 17109012. 
  2. ↑ "Helminth-host immunological interactions: prevention and control of immune-mediated diseases". Annals of the New York Academy of Sciences 1247 (1): 83–96. January 2012. doi:10.1111/j.1749-6632.2011.06292.x. PMID 22239614. Bibcode: 2012NYASA1247...83E. 
  3. ↑ Shubin, Neil (2008). Your inner fish : a journey into the 3.5-billion-year history of the human body (1st ed.). New York: Pantheon Books. ISBN 9780375424472. https://archive.org/details/yourinnerfishjou00shub_0. 
  4. ↑ "Evolution in health and medicine Sackler colloquium: Making evolutionary biology a basic science for medicine". Proceedings of the National Academy of Sciences of the United States of America. 107 107 Suppl 1 (suppl_1): 1800–7. January 2010. doi:10.1073/pnas.0906224106. PMID 19918069. Bibcode: 2010PNAS..107.1800N. 
  5. ↑ 5.0 5.1 "Core principles of evolutionary medicine: A Delphi study". Evolution, Medicine, and Public Health 2018 (1): 13–23. 2017-12-26. doi:10.1093/emph/eox025. PMID 29493660. 
  6. ↑ 6.0 6.1 "Issues in evolutionary medicine". American Journal of Human Biology 17 (2): 131–40. 2005. doi:10.1002/ajhb.20105. PMID 15736177. 
  7. ↑ Sagan, Dorion; Skoyles, John R. (2002). Up from dragons: the evolution of human intelligence. New York: McGraw-Hill. pp. 240–1. ISBN 978-0-07-137825-3. https://archive.org/details/upfromdragonsevo00john/page/240. 
  8. ↑ "The Expensive-Tissue Hypothesis: The Brain and the Digestive System in Human and Primate Evolution". Current Anthropology 36 (2): 199–221. 1995. doi:10.1086/204350. 
  9. ↑ "The Evolution of Human Speech: Its Anatomical and Neural Bases". Current Anthropology 48 (1): 39–66. 2007. doi:10.1086/509092. http://www.cog.brown.edu/people/lieberman/pdfFiles/Lieberman%20P.%202007.%20The%20evolution%20of%20human%20speech,%20Its%20anatom.pdf. 
  10. ↑ "Good vs complementary genes for parasite resistance and the evolution of mate choice". BMC Evolutionary Biology 4 (1): 48. November 2004. doi:10.1186/1471-2148-4-48. PMID 15555062. 
  11. ↑ "Genetic conflicts in human pregnancy". The Quarterly Review of Biology 68 (4): 495–532. December 1993. doi:10.1086/418300. PMID 8115596. http://nrs.harvard.edu/urn-3:HUL.InstRepos:3153297. 
  12. ↑ "Pre-eclampsia: a parent–offspring conflict". Journal of Psychosomatic Obstetrics and Gynaecology 21 (3): 179–82. September 2000. doi:10.3109/01674820009075626. PMID 11076340. 
  13. ↑ "Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective". The American Journal of Medicine 84 (4): 739–49. April 1988. doi:10.1016/0002-9343(88)90113-1. PMID 3135745. 
  14. ↑ "Diabetes incidence and prevalence in Pima Indians: a 19-fold greater incidence than in Rochester, Minnesota". American Journal of Epidemiology 108 (6): 497–505. December 1978. doi:10.1093/oxfordjournals.aje.a112648. PMID 736028. 
  15. ↑ "Evolutionary health promotion". Preventive Medicine 34 (2): 109–18. February 2002. doi:10.1006/pmed.2001.0876. PMID 11817903. http://www.thepaleodiet.com/articles/Health%20Promotion%20Paper.pdf. Retrieved 2008-08-21. 
  16. ↑ "The ancestral human diet: what was it and should it be a paradigm for contemporary nutrition?". The Proceedings of the Nutrition Society 65 (1): 1–6. February 2006. doi:10.1079/PNS2005471. PMID 16441938. 
  17. ↑ "Micronutrient intakes of wild primates: are humans different?". Comparative Biochemistry and Physiology. Part A, Molecular & Integrative Physiology 136 (1): 47–59. September 2003. doi:10.1016/S1095-6433(03)00084-9. PMID 14527629. http://nature.berkeley.edu/miltonlab/pdfs/kmilton_micronutrient.pdf. 
  18. ↑ "Diet, microorganisms and their metabolites, and colon cancer". Nature Reviews. Gastroenterology & Hepatology 13 (12): 691–706. December 2016. doi:10.1038/nrgastro.2016.165. PMID 27848961. 
  19. ↑ 19.0 19.1 Aubrey D.N.J, de Grey (2007). "Life Span Extension Research and Public Debate: Societal Considerations". Studies in Ethics, Law, and Technology 1 (1, Article 5). doi:10.2202/1941-6008.1011. http://www.sens.org/files/pdf/ENHANCE-PP.pdf. Retrieved August 7, 2011. 
  20. ↑ "Realigning our 21st century diet and lifestyle with our hunter-gatherer genetic identity". Directions Psych 25: SR1–SR10. 2005. http://www.thepaleodiet.com/articles/Dir%20Psych%202005.pdf. Retrieved 2008-08-21. 
  21. ↑ Eaton, S. Boyd; Cordain, Loren; Sebastian, Anthony (2007). "The Ancestral Biomedical Environment". in Aird, William C.. Endothelial Biomedicine. Cambridge University Press. pp. 129–34. ISBN 978-0-521-85376-7. http://www.thepaleodiet.com/articles/Ancestral%20Biomedical%20Environment%20Final.pdf. 
  22. ↑ "An evolutionary perspective on human physical activity: implications for health". Comparative Biochemistry and Physiology. Part A, Molecular & Integrative Physiology 136 (1): 153–9. September 2003. doi:10.1016/S1095-6433(03)00208-3. PMID 14527637. 
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  26. ↑ http://www.microbemagazine.org/index.php ? option=com_content&view=article&id=4700:a-darwinian-view-of-the-hygiene-or-old-friends- hypothesis&catid=950&Itemid=1301
  27. ↑ "Hygiene and the world distribution of Alzheimer's disease: Epidemiological evidence for a relationship between microbial environment and age-adjusted disease burden". Evolution, Medicine, and Public Health 2013 (1): 173–86. January 2013. doi:10.1093/emph/eot015. PMID 24481197. 
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  30. ↑ 30.0 30.1 Straub, R. H., del Rey, A., Besedovsky, H. O. (2007) "Emerging concepts for the pathogenesis of chronic disabling inflammatory diseases: neuroendocrine-immune interactions and evolutionary biology" In: Ader, R. (2007) "Psychoneuroimmunology", Volume 1, Academic Press, San Diego, pp.217-232
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  32. ↑ 32.0 32.1 "Pleiotropy, Natural Selection, and the Evolution of Senescence". Evolution 11 (4): 398–411. 1957. doi:10.2307/2406060. http://grad.bio.uci.edu/ecoevo/crauser/pdf_files/Williams%201957.pdf. Retrieved 2008-12-29.  abstract
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  63. ↑ Gaulin, Steven J. C. and Donald H. McBurney. Evolutionary psychology. Prentice Hall. 2003. ISBN:978-0-13-111529-3, Chapter 1, p 1-24.
  64. ↑ Buss, D.M. (2011). Evolutionary Psychology.
  65. ↑ Gaulin & McBurney (2004), Evolutionary Psychology
  66. ↑ Workman & Reader (2004), Evolutionary Psychology
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  75. ↑ "On Aims and Methods in Ethology". Zeitschrift für Tierpsychologie 20 (4): 410–433. 1963. doi:10.1111/j.1439-0310.1963.tb01161.x. http://www.rockefeller.edu/bard/pdfs/week_02_tinbergen_on_aims_and_methods_of_ethology_zft_1963.pdf. [yes|permanent dead link|dead link}}]
  76. ↑ "Evolution: medicine's most basic science". Lancet 372 (Suppl 1): S21–7. December 2008. doi:10.1016/S0140-6736(08)61877-2. 
  77. ↑ "Evolutionary biology and the treatment of signs and symptoms of infectious disease". Journal of Theoretical Biology 86 (1): 169–76. September 1980. doi:10.1016/0022-5193(80)90073-9. PMID 7464170. Bibcode: 1980JThBi..86..169E. 
  78. ↑ "The dawn of Darwinian medicine". The Quarterly Review of Biology 66 (1): 1–22. March 1991. doi:10.1086/417048. PMID 2052670. 
  79. ↑ Brody, Jane E. (2000-06-06). "PERSONAL HEALTH; What Could Be Good About Morning Sickness? Plenty" (in en-US). The New York Times. ISSN 0362-4331. https://www.nytimes.com/2000/06/06/health/personal-health-what-could-be-good-about-morning-sickness-plenty.html. 

Further reading

Books

  • Williams, George; Nesse, Randolph M. (1996). Why We Get Sick: the new science of Darwinian medicine. New York: Vintage Books. ISBN 978-0-679-74674-4. 
  • Evolution in health and disease (2nd ed.). Oxford [Oxfordshire]: Oxford University Press. 2008. ISBN 978-0-19-920745-9. 
  • McKenna, James J.; Trevathan, Wenda; Smith, Euclid O. (2008). Evolutionary medicine and health: new perspectives (2nd ed.). Oxford [Oxfordshire]: Oxford University Press. ISBN 978-0-19-530706-1. 
  • O'Higgins, Paul; Elton, Sarah (2008). Medicine and Evolution: Current Applications, Future Prospects (Society for the Study of Human Biology Symposium Series (Sshb). Boca Raton: CRC. ISBN 978-1-4200-5134-6. 
  • Ewald, P. W. (1996). Evolution of Infectious Disease. Oxford: Oxford University Press. ISBN 978-0-19-511139-2. 
  • Survival of the Sickest. New York: HarperLuxe. 2007. ISBN 978-0-06-088965-4. 

Online articles

External links




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