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Unformatted text preview: ORIGINAL ARTICLE The great opportunity: Evolutionary applications to medicine and public health Randolph M. Nesse 1 and Stephen C. Stearns 2 1 The University of Michigan 2 Yale University The gap Of evolutionary biologys many practical applications, those in medicine are the most obvious and potentially the most important. So far, however, medicine, nursing and public health have made use of only a fraction of what evolution has to offer. The magnitude of the gap is impressive. Studies of medical education found that most medical schools in the UK and the USA have not one evo- lutionary biologist on the faculty (Nesse and Schiffman Keywords Darwinian, disease, evolution, medicine, public health. Correspondence Randolph M. Nesse, The University of Michigan. Tel.: +1 734 764 6593; fax: +1 734 647 3652; e-mail: email@example.com Received: 4 October 2007 Accepted: 27 November 2007 doi:10.1111/j.1752-4571.2007.00006.x Abstract Evolutionary biology is an essential basic science for medicine, but few doctors and medical researchers are familiar with its most relevant principles. Most medical schools have geneticists who understand evolution, but few have even one evolutionary biologist to suggest other possible applications. The canyon between evolutionary biology and medicine is wide. The question is whether they offer each other enough to make bridge building worthwhile. What bene- fits could be expected if evolution were brought fully to bear on the problems of medicine? How would studying medical problems advance evolutionary research? Do doctors need to learn evolution, or is it valuable mainly for researchers? What practical steps will promote the application of evolutionary biology in the areas of medicine where it offers the most? To address these questions, we review current and potential applications of evolutionary biology to medicine and public health. Some evolutionary tech- nologies, such as population genetics, serial transfer production of live vaccines, and phylogenetic analysis, have been widely applied. Other areas, such as infec- tious disease and aging research, illustrate the dramatic recent progress made possible by evolutionary insights. In still other areas, such as epidemiology, psychiatry, and understanding the regulation of bodily defenses, applying evo- lutionary principles remains an open opportunity. In addition to the utility of specific applications, an evolutionary perspective fundamentally challenges the prevalent but fundamentally incorrect metaphor of the body as a machine designed by an engineer. Bodies are vulnerable to disease and remarkably resilient precisely because they are not machines built from a plan. They are, instead, bundles of compromises shaped by natural selection in small incre- ments to maximize reproduction, not health. Understanding the body as a product of natural selection, not design, offers new research questions and a framework for making medical education more coherent. We conclude withframework for making medical education more coherent....
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