Nothing in medicine makes sense

Nothing in biology makes sense except in the light of evolution

Theodosius Dobzhansky (1900-1975)

The same can, and should, be said of medicine. However as Catriona MacCallum notes:

It is curious that Charles Darwin, perhaps medicine’s most famous dropout, provided the impetus for a subject that figures so rarely in medical education…Yet an understanding of how natural selection shapes vulnerability to disease can provide fundamental insights into medicine and health and is no less relevant than an understanding of physiology or biochemistry.

MacCallum CJ (2007) Does Medicine without Evolution Make Sense?

When I began studying medicine I was surprised by the near-complete absence of evolution from the curriculum of my medical school (which gives a certain irony to this article by the former Dean of the selfsame medical school…). Only when I read Randolph Nesse and the late George C. Williams fascinating book, ‘Why We Get Sick‘ (1994) did I began to appreciate the profound importance of an evolutionary approach to human health and disease. I commend their ongoing efforts to make evolutionary biology one of the basic sciences of medicine, as exemplified by their Science editorial, ‘Medicine needs Evolution‘, and a paper titled ‘The Great Opportunity’ published in Evolutionary Applications. Hopefully the profile of evolutionary medicine will soar following the The Lancet’s special issue commemorating both the 200th anniversary of the birthday of Charles Darwin and the 150 years we have been the fortunate recipients of his greatest gift, ‘On the Origin of Species’…

An evolutionary approach to illness and disease studies not the evolution of the disease but the design characteristics that make us susceptible to the disease.

Nesse R and Williams GC (1994) Why We Get Sick

I now turn to Paul Ewald – speaking at TED – for a demonstration of how an evolutionary approach leads to a deeper understanding of infectious diseases, and offers hope for how they may be controlled.

But evolution is is not only relevant to infectious diseases and antibiotic resistance (which is really “evolution by any other name”). An evolutionary approach brings new understandings and insights to countless aspects of health and medicine, including:

  • the adaptive origins of psychiatric illness – e.g. depression [fulltext]
  • why we age – e.g. the “antagonistic pleiotropic” theory of aging [pdf]
  • cancer as an evolutionary process [pdf]
  • the persistence of genetic diseases such as sickle cell anaemia – e.g. heterozygote advantage.
  • why we are susceptible to “lifestyle diseases” – e.g. “the thrifty gene hypothesis“.
  • the adaptive value of morning sickness during pregnancy [pdf ]
  • the rise of allergies and autoimmune diseases since the advent of improved sanitation – e.g. “the hygiene hypothesis“.

To find out more visit the Evolution & Medicine Network and read about ‘the ten categories of evolutionary applications in medicine‘ (pdf).

I shall end with the oft-quoted and poetic close to the first edition of the most important book ever written:

There is grandeur in this view of life, with its several powers, having been originally breathed into a few forms or into one; and that, whilst this planet has gone cycling on according to the fixed law of gravity, from so simple a beginning endless forms most beautiful and most wonderful have been, and are being, evolved.

Darwin CR (1859)


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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